Marked by solid scholarship, measured criticism, and pithy comments: an informative and highly readable study that makes a...
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 more cost-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.Pub Date: Aug. 20, 2004
ISBN: 0-375-41483-5
Page Count: 480
Publisher: Knopf
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: June 15, 2004
Useful but disappointingly commonplace tips.
In a follow-up to The End of Illness (2012), which explored how technological advances will transform medicine, Agus (Medicine and Engineering/Univ. of Southern California) restates time-tested but too often overlooked principles for healthy living.
The author outlines simple measures that average citizens can take to live healthier lives and extend their life spans by taking advantage of modern technology to develop personalized records. These would include a list of medical tests and recommended treatments. Agus also suggests keeping track of indicators that can be observed at home on a regular basis—e.g., changes in energy, weight, appetite and blood pressure, blood sugar and general appearance. He advises that all of this information be made available online, and it is also helpful to investigate family history and consider DNA testing where indicated. Along with maintaining a healthy weight, Agus emphasizes the importance of eating a balanced diet, with plenty of fresh fruits and vegetables and a minimum of red meat. Avoid packaged vitamins and food supplements, and if possible, grow your own vegetables or buy frozen vegetables, which will generally be fresher than those on supermarket shelves. The author also warns against processed foods that make health claims but contain additives or excessive amounts of sugar or fat. Regular mealtimes and plenty of sleep, frequent hand-washing and oral hygiene are a must; smoking and excessive time in the sun should also be avoided. Agus recommends that adults should consider taking statins and baby aspirin as preventative measures. He concludes with a decade-by-decade checklist of annual medical examinations that should be routine—e.g. blood pressure, diabetes and cholesterol screenings, from one’s 20s on; colonoscopies, prostate exams and mammograms later—and a variety of top-10 lists (for example, “Top 10 Reasons to Take a Walk”).
Useful but disappointingly commonplace tips.Pub Date: Jan. 7, 2014
ISBN: 978-1-4767-3095-0
Page Count: 128
Publisher: Simon & Schuster
Review Posted Online: Sept. 30, 2013
Kirkus Reviews Issue: Oct. 15, 2013
BOOK REVIEW
BOOK REVIEW
Oncologist Agus (Medicine and Engineering/Univ. of Southern California) predicts that the application of advanced technology for modeling complex systems will transform 21st-century medicine.
The author writes that a remark Nobel Laureate Murray Gell-Mann made to him in 2009—“Look at cancer as a system"—transformed the way he views his own specialty and the entire field of preventative medicine. It made him realize that “[r]ather than honoring the body as the exceedingly complex system that it is, we keep looking for the individual gene that has gone awry, or for the one ‘secret’ that can improve our health.” Agus writes that although the ability to sequence the entire human genome is a great step forward, it is insufficient for achieving a significant breakthrough. Even though it may start with a mutation, cancer “is a dynamic process that's happening…far from the confines of a static piece of DNA”—it involves the body's immune system, its ability to regulate cell growth, metabolism and more. Agus directs his university’s Center for Applied Molecular Medicine and is the co-founder of two personalized medicine companies, Applied Proteomics and Navigenics. His hope is that their research will contribute to developing better analytical tools for preventative medicine and for the treatment of cancers. These will address the functioning of the body as a whole, applying digital technology already used by physicists to provide virtual models of cancers and model the action of proteins that regulate cell communication in the body. He also hopes to develop tools that will provide information on the concentration of different proteins in a drop of blood taken from a patient, which may reveal the onset of disease. The author also includes some guiding principles and warnings about certain healthy practices that may not be so healthy. A refreshing change of pace in the medical field, but by venturing beyond his field of expertise to pontificate on a wide range of subjects, Agus makes his otherwise intriguing narrative difficult to follow.
Pub Date: Jan. 1, 2012
ISBN: 978-1-4516-1017-8
Page Count: 288
Publisher: Free Press
Review Posted Online: Nov. 5, 2011
Kirkus Reviews Issue: Nov. 15, 2011
BOOK REVIEW
BOOK REVIEW
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