A masterful assessment of a highly flawed health care system.
Unsettling news about prescription drugs.
Avorn, professor of medicine at Harvard Medical School, reminds readers that pharmaceutical companies, despite bitter opposition, were required to prove that their drugs worked beginning only in 1962. Ironically, their first mass support came from radicals when 1980s AIDS activists denounced the neglect and slow pace of anti-AIDS drug approval. Responding, the FDA created an Accelerated Approval program to release drugs quickly based on “surrogate” clinical endpoints. For example: If, early in research, an anti-diabetic drug lowers blood sugar, that’s a hopeful surrogate sign, and it may be approved. But lowering blood sugar does nothing to prevent heart disease, blindness, infections, and other diseases that afflict diabetics. Sensibly, the FDA insists that research proceed, but drug companies avoid this. A drug proven effective does not increase profits because it’s already approved, and failure is disaster. As a result, most drugs approved today haven’t been shown to benefit patients, and an unnerving number, many wildly expensive, are considered useless by experts, if not by their manufacturers. Others are toxic, but, Avorn writes, “for decades the FDA had a kind of attention deficit disorder concerning drugs it has already approved.” Vioxx, an anti-inflammatory similar to Motrin or Advil, became the world’s bestseller after its 1999 approval. It also greatly increased the risk of heart attacks and strokes, although five years passed before it was pulled from the market. Similar debacles abound, so readers may breathe a sigh of relief at the author’s diversions into his life and career at Harvard Medical School, where, he writes, “one eminent department chair…had a standard response to faculty recruits who balked at the paltry academic salaries he was offering them: ‘Just think of it as a base. You can earn much more, maybe double that amount, by consulting for drug companies.’” Avorn provides sensible solutions, but many involve increased government oversight, which seems unlikely these days.
A masterful assessment of a highly flawed health care system.Pub Date: April 22, 2025
ISBN: 9781668052846
Page Count: 496
Publisher: Simon & Schuster
Review Posted Online: Feb. 15, 2025
Kirkus Reviews Issue: March 15, 2025
BOOK REVIEW
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
A philosophically rich critique of state violence and mass apathy.
An Egyptian Canadian journalist writes searchingly of this time of war.
“Rules, conventions, morals, reality itself: all exist so long as their existence is convenient to the preservation of power.” So writes El Akkad, who goes on to state that one of the demands of modern power is that those subject to it must imagine that some group of people somewhere are not fully human. El Akkad’s pointed example is Gaza, the current destruction of which, he writes, is causing millions of people around the world to examine the supposedly rules-governed, democratic West and declare, “I want nothing to do with this.” El Akkad, author of the novel American War (2017), discerns hypocrisy and racism in the West’s defense of Ukraine and what he views as indifference toward the Palestinian people. No stranger to war zones himself—El Akkad was a correspondent in Afghanistan and Iraq—he writes with grim matter-of-factness about murdered children, famine, and the deliberate targeting of civilians. With no love for Zionism lost, he offers an equally harsh critique of Hamas, yet another one of the “entities obsessed with violence as an ethos, brutal in their treatment of minority groups who in their view should not exist, and self-decreed to be the true protectors of an entire religion.” Taking a global view, El Akkad, who lives in the U.S., finds almost every government and society wanting, and not least those, he says, that turn away and pretend not to know, behavior that we’ve seen before and that, in the spirit of his title, will one day be explained away until, in the end, it comes down to “a quiet unheard reckoning in the winter of life between the one who said nothing, did nothing, and their own soul.”
A philosophically rich critique of state violence and mass apathy.Pub Date: Feb. 25, 2025
ISBN: 9780593804148
Page Count: 224
Publisher: Knopf
Review Posted Online: Dec. 14, 2024
Kirkus Reviews Issue: Jan. 15, 2025
BOOK REVIEW
BOOK REVIEW
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