Environmental Valuation & Cost-Benefit News

by Jerry Avorn, M.D. Price: $27.50 ISBN: 0-375-41483-5


FROM THE PUBLISHER


"This is a comprehensive behind-the-scenes look at issues that affect everyone: our shortage of data comparing the worth of similar drugs for the same condition; alarming lapses in the detection of lethal side effects; the underuse of life-saving medications; lavish marketing campaigns that influence what doctors prescribe; and the resulting upward spiral of costs that places vital drug beyond the reach of many Americans." Using clinical case histories taken from his own work as a practitioner, researcher, and advocate, Dr. Avorn demonstrates the impressive power of the well-conceived prescription as well as the debacles that can result when medications are misused. He describes an innovative program that employs the pharmaceutical industry's own marketing techniques to reduce use of some of the most overprescribed and overpriced products. Powerful Medicines offers timely and practical advice on how the nation can improve its drug-approval process, and how patients can work with doctors to make sure their prescriptions are safe, effective, and as affordable as possible.


FROM THE CRITICS


Publisher's Weekly


In this pragmatic volume, Avorn sets out an impressive plan for the American health care system to get helpful drugs to those who need them, protect patients from dangerous side effects and keep costs within reasonable limits. Avorn, chief of the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston, argues, "[F]or a sum no greater than our current drug budget, medications could provide all Americans with the most productive and cost-effective interventions in all of health care." Avorn claims, "[W]e waste billions of dollars a year on prescription drugs that are excessively priced, poorly prescribed, or improperly taken." To remedy this situation, reform is needed in how new drugs are approved and marketed. In addition, practicing physicians need access to state-of-the-art information about new medications, including how well they compare to established (and often cheaper) products. Computer technology, Avorn shows, can bring together the latest information on treatment options and drug contraindications. But changes in the pharmaceutical industry itself-of which Avorn does not hold a flattering view-may be necessary to eliminate pressure to prescribe the most heavily advertised and costly new product when old standbys are equally effective. Though this informative and witty book is overly long, it makes a compelling case for prescription sanity and shows how constructive change can realistically be achieved. (Aug. 20) Copyright 2004 Reed Business Information.


Library Journal


Avorn brings 30 years' experience as a physician and researcher to the current debate about pharmaceuticals. In the opening sections, "Benefits" and "Risks," he provides an excellent overview of the research techniques necessary to evaluate a drug's safety and effectiveness, while in "Cost" and "Information" he covers some of the same territory as Merrill Goozner's The $800 Million Pill and Stephen Ceccoli's Pill Politics regarding the development, marketing, and pricing of new drugs. Avorn's analysis, however, goes further than just criticizing the industry-he puts drug costs in the bigger picture of health resource allocation while pointing out the difficulty that both doctors and patients face in trying to find unbiased information. In the fifth and final section, he suggests more rational public policy. Avorn's coverage is thorough and his writing style engaging and even humorous. While accessible to lay readers, this title would also be an appropriate text for health sciences students. Highly recommended.-Eris Weaver, Redwood Health Lib., Petaluma, CA Copyright 2004 Reed Business Information.


Kirkus Reviews


Cogent analysis of how pharmaceutical drugs are approved, promoted, and prescribed in this country, with some well-considered recommendations for improving the present system. According to Avorn (Medicine/Harvard Medical School), Americans waste billions of dollars on prescription drugs that are overpriced, poorly prescribed, and improperly taken. He draws on his extensive experience as researcher and physician to explore the relationships between benefits, risks, and the economic impact of prescription drugs. While the FDA comes under scrutiny for its failure to properly assess the risks of such medications as the diet drug Redux and the diabetes drug Rezulin, this is not another FDA-bashing book. Avorn's picture is bigger. Through case studies, he examines decisions made by the regulatory agencies, pharmaceutical companies, health policymakers, and physicians that reveal faults in the entire system. After examining how benefits and risks are discovered and measured, he turns to the difficult question of how these are balanced against each other when making decisions about a drug's use. Avorn finds that in the real world, the major source of information about drugs is the promotion departments of pharmaceutical companies. Surrounded by "an almost suffocating plethora of information of very uneven quality," physicians have not been prepared by their medical education to deal with it. He proposes an educational outreach program based in medical schools that would send academic "detail men" to doctors' offices just as drug companies do. They would provide neutral, evidence-based assessment of drug choices so that physicians would know which treatments were more better, safer, and morecost-effective. Avorn points to Canada, Australia, and Great Britain as countries whose drug-assessment procedures we can learn from. His final chapters offer concrete, practical ideas for improving the ways in which drugs are evaluated and pertinent information about them is disseminated. Marked by solid scholarship, measured criticism, and pithy comments: an informative and highly readable study that makes a significant contribution to the ongoing discussion of an important health care issue.

Random House/Knopf www.randomhouse.com