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 smart, rewarding consideration of football’s popularity—and eventual downfall.
A wide-ranging writer on his football fixation.
Is our biggest spectator sport “a practical means for understanding American life”? Klosterman thinks so, backing it up with funny, thought-provoking essays about TV coverage, ethical quandaries, and the rules themselves. Yet those who believe it’s a brutal relic of a less enlightened era need only wait, “because football is doomed.” Marshalling his customary blend of learned and low-culture references—Noam Chomsky, meet AC/DC—Klosterman offers an “expository obituary” of a game whose current “monocultural grip” will baffle future generations. He forecasts that economic and social forces—the NFL’s “cultivation of revenue,” changes in advertising, et al.—will end its cultural centrality. It’s hard to imagine a time when “football stops and no one cares,” but Klosterman cites an instructive precedent. Horse racing was broadly popular a century ago, when horses were more common in daily life. But that’s no longer true, and fandom has plummeted. With youth participation on a similar trajectory, Klosterman foresees a time when fewer people have a personal connection to football, rendering it a “niche” pursuit. Until then, the sport gives us much to consider, with Klosterman as our well-informed guide. Basketball is more “elegant,” but “football is the best television product ever,” its breaks between plays—“the intensity and the nothingness,” à la Sartre—provide thrills and space for reflection or conversation. For its part, the increasing “intellectual density” of the game, particularly for quarterbacks, mirrors a broader culture marked by an “ongoing escalation of corporate and technological control.” Klosterman also has compelling, counterintuitive takes on football gambling, GOAT debates, and how one major college football coach reminds him of “Laura Ingalls Wilder’s much‑loved Little House novels.” A beloved sport’s eventual death spiral has seldom been so entertaining.
A smart, rewarding consideration of football’s popularity—and eventual downfall.Pub Date: Jan. 20, 2026
ISBN: 9780593490648
Page Count: 304
Publisher: Penguin Press
Review Posted Online: Oct. 24, 2025
Kirkus Reviews Issue: Dec. 1, 2025
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
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