OVER DOSE

A well-planned and documented exposé of how pharmaceutical companies market drug information and how their one-size-fits-all dosage recommendations harm patients.

Cohen (Family and Preventive Medicine; Psychiatry/Univ. of California, San Diego) charges that drug companies adopt an overly simplistic approach in recommending dosages and that unnecessarily high ones increase the risk of damage or even deadly side effects. He illustrates the problems created by overdoses of such popular drugs as Prozac, Viagra, estrogen formulations, and medications for cholesterol reduction and control of hypertension. Because older people frequently require lower dosages, he devotes an entire chapter to the medications most likely prescribed for seniors, calling on drug companies to determine the lowest safe and effective doses and to publish this information in the Physician’s Desk Reference (PDR) and in package inserts. While doctors generally rely on data in the annual PDR given them gratis by the industry, he says, this information is based on limited studies and rarely updated. Urgently needed is a comprehensive, independent, and current drug reference readily accessible to all physicians and patients. Further, Cohen examines drug companies’ manipulation of research and handling of research findings, and he looks at the relationship between the drug industry and the FDA, suggesting reforms to strengthen that agency and calling for establishment of a national medication safety board to monitor the safety of new drugs and develop strategies for improving the dissemination of information about them. His own rule of thumb is to start low and go slow, though he prudently cautions readers not to halt or adjust their own medications without consulting a doctor.

A call and for action and a plan for it as well. Though not intended as a comprehensive reference, Over Dose is a source of useful drug information, much of it tabulated at chapter ends for easy consultation.