drugs, and attendant benefits, risks and costs, are the cynosure of the vastly-illumining
and immensely-enthralling, if somewhat disheartening, tome entitled Powerful
Medicines. Highly-gifted writer,
and sole author, Jerry Avorn is an Associate
Professor of Medicine, at Harvard Medical School. The primal message imparted by Avorn, in
unequivocally blunt, albeit non-abrasive, fashion, is that every drug has three
benefits) face; a potentially-deadly, side-effects (or risks) face; and, also
importantly, an economically-rooted (or costs) face; and it is imperative for
the three faces to be brought into much-better balance, in vigorous pursuit of
optimizing the public's health.
the expansive corpus of the brilliantly-written text, Avorn remonstrates
relentlessly, and soberingly, regarding the cruel paradox of
pharmaceuticals: the potential healing
powers of medicines, on the one hand; but, alas, their potential for
highly-deleterious, even deadly, side effects, on the other. Also, and quite significantly, interlaced
into this paradoxically-woven tapestry is the problematically-exorbitant
economic costs, of medicines.
facile, but wrong, for critics to cast aside the contemplative musings, of
Avorn, as simply constituting an unfair caricature of the pharmaceutical
industry as being obsessively commercial-centric, and insufficiently attentive
to ethics and the public's health.
Avorn, in fact, is often quite critical of pharmaceutical-industry
practices; and the Food and Drug Administration, as well, is often pilloried. But, it is also true that the
enthrallingly-expert commentary, of Avorn, is perspicaciously filtered through
the quite-discerning prism of Avorn's long-standing, and broad-ranging,
professional experiences, as a:
clinician, epidemiologist, and health-policy and drug researcher.
infectiously-visceral way, Avorn is enormously respectful of ethics, and
extremely mindful of the primacy of the public's health. Avorn unabashedly decries perceived flaws of
America's marketplace model of healthcare, which work at cross purposes with
optimal public health; and believes that, with respect to drugs, and healthcare
in general, the extant, defect-ridden U.S. healthcare system must be
substantially reorganized so as to be tethered securely to the transcendent
goal of greatly improving the public's health.
sensibly be gainsaid that the wellsprings of profound insight and knowledge,
embedded in the text, should help slake the intellectual thirst of those
coveting the imbibing of deep waters of erudition, germane to drugs, and
accompanying benefits, risks, and costs.
Writing with gritty determination, measured hopefulness, and with a
not-unreasonable sense of urgency, Avorn has beautifully crafted a refreshingly-candid
and delectably-edifying book, which, truthfully, is very properly of pertinent
interest to all Americans.
Structurally, five "parts", which ramify into twenty-three
chapters, comprise the mainstay pillars, supporting the book's structural
foundation. A riveting prologue functions
as an exordium to the trunk of the textual body. The crux of the adroitly-prepared first part of the book is the
quite-vexing question of whether or not a particular medicine
"works", in terms of therapeutic efficacy. In the highly instructive, if somewhat-dispiriting, second part
of the book, Avorn sharply focuses rapt attention on drugs, and allied
risks. Very skillfully employing a
case-study format, to conduct engrossingly revealing "autopsies",
with respect to problematic drugs, Avorn retraces, in detail-laden, critical
fashion, the dreary regulatory and marketing trails of several drugs. Particularly, case studies of the drugs
Redux, Rezulin, and phenylpropanolamine distressingly show egregious failures
with respect to drug risk assessment; and are striking, and disquieting,
evidence of how the benefit-risk balance between drug-associated healing and
harm can get badly out-of-control. The
increasingly-onerous economic costs of medicines, and increasingly-desperate
efforts to contain such costs, are at the core of the book's third part. The over-arching concern of the book's
fourth part is attached firmly to real-life, information-related factors
impinging on the writing of prescriptions by clinicians ensconced in the
labyrinthine U.S. healthcare system, and provides bluntly-critical commentary
appertaining to the real-life tug of war between the deluge of promotional
materials poured on clinicians by the pharmaceutical industry in competition
with scientific-evidence-based information, regarding drugs. Finally, in the last part of the book,
Avorn, exuding trenchant determination, discourses on the salient need for
effectual harmonizing, of drug-related benefits, risks, and costs, by means of
judicious policy and regulatory interventions and innovations. A fairly limited number of well-annotated
research "Notes" adjoin the textual body, and may efficaciously serve
as a conduit, leading to further study of particular areas of research interest
to individual readers.
immensely-intellectually-powerful ax, forged in the fire of his very
considerable, real-life experiences as a clinical practitioner-researcher
physician, Avorn toilsomely chops away at multifarious perceived deficiencies
plaguing the pharmaceutical industry, and America's marketplace approach to
healthcare generally. Avorn's vast
array of shrewd observations and insights are enshrouded by his manifest, very
scrupulous honesty and integrity.
it should be noted, is not for the intellectually timid. Avorn's multitudinous questions are often
deeply-probing; and his observations and answers may be quite unsettling. Truth, as Avorn lucidly sees it, is
revealed, with no attempt made to shield warts and blemishes, however
ugly. Healthcare clinicians and researchers,
public-health professionals, economists, policy makers and lawyers intertwined
professionally with the healthcare field, epidemiologists, pharmacists,
ethicists, and persons enmeshed in the pharmaceutical and health-insurance
industries, are among those who should benefit greatly from this superb book.
© 2005 Leo Uzych
Leo Uzych (based in Wallingford,PA) earned a law
degree, from Temple University; and a master of public health degree, from
Columbia University. His area of
special professional interest is healthcare.