Overdosed America: The Broken Promise of American Medicine

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Overview

Using the examples of Vioxx, Celebrex, cholesterol-lowering statin drugs, and anti-depressants, Overdosed America shows that at the heart of the current crisis in American medicine lies the commercialization of medical knowledge itself.

Drawing on his background in statistics, epidemiology, and health policy, John Abramson, M.D., reveals the ways in which the drug companies have misrepresented statistical evidence, misled doctors, and compromised our health. The good news is that the best scientific evidence shows that reclaiming responsibility for your own health is often far more effective than taking the latest blockbuster drug.

You—and your doctor—will be stunned by this unflinching exposé of American medicine.

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Editorial Reviews

From Barnes & Noble
For 20 years, in a small town north of Boston. Dr. John Abramson labored as a family physician. As the years passed, he realized that his job was changing; that his role as a health care provider was being steadily undermined by new drugs and expensive treatments for every symptom. Increasingly skeptical, he began to draw on his background in statistics, epidemiology, and health policy research. He discovered that medical knowledge has become commercialized: More than 70 percent of clinical studies are now funded by pharmaceutical and medical device companies. The artificial creation of demand had helped create an American health care that is as inefficient as it is costly. Although U.S per capita spending on health care is twice that of other industrialized countries, our health ranks at the bottom. As informed investigative journalism, Rx America ranks high.
Publishers Weekly
According to Abramson, Americans are overmedicated and overmedicalized as a result of the commercialization of health care. Falling prey to marketing campaigns, we demand unnecessary and expensive drugs and procedures, believing they constitute the best possible medical care. Wrong, says Abramson: though more post-heart attack procedures are performed in the U.S. than in Canada, one-year survival rates are the same. Similarly, notes Abramson, a former family practitioner who teaches at Harvard Medical School, we spend more on high-tech neonatology than other Western countries but have a higher infant-mortality rate because of inattention to low-tech prenatal care. Abramson deconstructs the scientific sleight of hand in presenting clinical trial results that leads to the routine prescription of pricey cholesterol-lowering drugs even when their effectiveness has not been proven; he examines what he calls "supply-sensitive medical services"-the near-automatic use of medical technologies, such as cardiac catheterization, less because they are needed than because they are available. Abramson's bottom line: "More care doesn't necessarily mean better care." Arguing firmly that doctors should focus more on lifestyle changes to improve health, Abramson seems less credible when he writes off depression as "exercise-deficiency disease" and disposes of cancer in little more than a page. Still, he makes a powerful and coherent case that American medicine has gone badly astray and needs a new paradigm-one untainted by profits. Agent, Kris Dahl. (Oct.) Copyright 2004 Reed Business Information.
Library Journal
With healthcare based on research sponsored mainly by self-interested drug companies, we're all in trouble, argues family practitioner Abramson. With a three-city author tour. Copyright 2004 Reed Business Information.
The Oregonian (Portland)
“Abramson’s book will have you rethinking your relationship with your doctor and your health.”
Washington Post Book World
“Enlightening.”
Eric Schlosser
“Before you see a doctor, you should read this book.”
Herbert Benson
“A clear and concise explanation of how American medicine has gone astray...a must read for both patients and doctors.”
Barbara Starfield
“Fulfills the criteria for high quality in health services: the right diagnosis and the right prescription at the right time.”
Elliott Fisher
“Acompelling and well-documented analysis... a book every American should read.”
Cheryl Richardson
“Essential for all those who want to intelligently reclaim responsibility for their own health.”
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Product Details

  • ISBN-13: 9780060568528
  • Publisher: HarperCollins Publishers
  • Publication date: 9/21/2004
  • Pages: 288
  • Product dimensions: 6.38 (w) x 9.24 (h) x 1.11 (d)

Meet the Author

John Abramson, M.D., has worked as a family doctor in Appalachia and in Hamilton, Massachusetts, and has served as chairman of the department of family practice at Lahey Clinic. He was a Robert Wood Johnson Fellow and is on the clinical faculty of Harvard Medical School, where he teaches primary care.

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Table of Contents

Introduction xi
Part I A Family Doctor's Journey of Discovery 1
Chapter 1 Medicine in Transition: Caring for Patients at the Crossroads 3
Chapter 2 Spinning the Evidence: Even the Most Respected Medical Journals Are Not Immune 13
Chapter 3 False and Misleading: The Misrepresentation of Celebrex and Vioxx 23
Chapter 4 The Myth of Excellence 39
Chapter 5 A Case in Point: The Saga of Hormone Replacement Therapy 55
Part II The Commercialization of American Medicine 73
Chapter 6 American Medicine's Perfect Storm: A Brief History 75
Chapter 7 The Commercial Takeover of Medical Knowledge 93
Chapter 8 The Snake and the Staff: Duping the Doctors 111
Chapter 9 A Smoking Gun: The 2001 Cholesterol Guidelines 129
Chapter 10 Direct-to-Consumer: Advertising, Public Relations, and the Medical News 149
Chapter 11 Follow the Money: Supply-Side Medical Care 169
Part III Taking Back Our Health 187
Chapter 12 The Knee in Room 8: Beyond the Limits of Biomedicine 189
Chapter 13 From Osteoporosis to Heart Disease: What the Research Really Shows About Staying Healthy 209
Chapter 14 Healing Our Ailing Health Care System, or How to Save $500 Billion a Year While Improving Americans' Health 241
Notes 261
Bibliography 307
Acknowledgments 311
Index 315
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First Chapter

Overdosed America
The Broken Promise of American Medicine

Chapter One

Medicine in Transition

Caring for Patients at the Crossroads

The air was hot and muggy even by Amazon standards. It was the end of an exhausting but very satisfying day of doctoring indigenous people of all ages in a two-room school building temporarily transformed into clinic for this small medical mission. We were putting the medical equipment and records away, and I was thinking about how nice a cool shower was going to feel, when our interpreter approached me with a look of concern and asked if I would make a house call to a woman who was too sick to come to our makeshift clinic.

Several villagers led me across an open field and down a narrow dirt path to the sick woman's open cabin. As we approached, I could see her lying still in a hammock. Her husband was sitting nervously by her side and her four young children were darting playfully in and out of the cabin, pausing for just a moment to check on their sick mother. As I sat down next to her, I could tell from her detached, pained, and frightened look that she was seriously ill. Even the subtle facial expression she mustered to greet me seemed to cause her pain.

I was introduced to the sick woman and her husband by our interpreter, and learned that she had had a spontaneous miscarriage severel days before. The pain in her belly and vomiting had been getting worse for the past two days. I asked if I could examine her. She responded with a minimal nod and looked over to her husband to make sure that he agreed. Her temperature was now 103 degrees. Her abdomen was stiff and exquisitely tender to even the slightest touch. Most likely she had developed a uterine infection as a consequence of an incomplete miscarriage, and the infection had spread throughout her abdominal cavity, causing peritonitis. She needed to be hospitalized for intravenous antibiotics and fluids, and she needed dilatation and curettage of her uterus -- a D and C-to remove the infected tissue.

Her husband and several other villagers listened attentively as I explained my diagnosis. But their expressions changed from hope to despair when I told them that she needed to be treated in a hospital. They said that she couldn't go to the hospital because they did not have any money. I suggested that they take her there anyway and that someone would care for her. They said that wouldn't work, that she would be ignored, left to die on the hospital steps. I asked how much it would cost for her to get hospital care. They said $160. The two other Americans present and I glanced at one another and agreed, without a word being spoken, that we would get the money together. Fortunately, a boat soon came by, headed in the right direction, and off she went, accompanied by our capable interpreter, who could help her with travel and hospital arrangements. The woman returned to the village three days later, weak but much improved. Her look of fear was gone. Her husband and children stared in happy disbelief when they first saw her and realized she would recover.

When I got back home, I went to my office the Sunday before resuming my normal schedule to go through the paperwork that had accumulated while I was away. Among the several 3-foot-high stacks of patients' charts, test results, consultants' notes, medical journals, and junk mail was the latest issue of the Journal of the American Medical Association (JAMA), from November 24, 1999. I noticed an article about Celebrex and one about Vioxx, the latest drugs for arthritis pain. Each article presented the results of a study sponsored by the drug's manufacturer claiming that the drug was significantly safer than older anti-inflammatory medication, which was available in much less costly generic form.

The accompanying editorial -- these are typically included in medical journals to provide expert perspective on the most noteworthy articles published in each issue -- reported with unusual candor (especially since both authors had financial ties to at least one of the manufacturers of the new drugs) that neither of the new anti-inflammatory drugs provided better relief of symptoms than the older alternatives. The editorial also explained that the highly touted safety benefits of the new drugs appeared minimal in people who were not at high risk of developing serious gastrointestinal side effects. So minimal, the editorial said, that 500 such people would have to be treated for one full year with the new drugs instead of the older anti-inflammatory drugs to prevent just one serious but nonfatal stomach ulcer. Based on the difference in price between the new and older anti-inflammatory drugs, the editorial calculated that the cost of each serious ulcer thus prevented was $400,000.

Still moved by my experience in the Amazon, I wondered how many lives like that of the woman to whom I had made the house call might be saved for the cost of preventing a single nonfatal stomach ulcer by using Celebrex or Vioxx. I took out my calculator to see how many times $160 goes into $400,000. I could feel myself change when I saw the figure "2500" on the display and realized the injustice of that equation. Though I didn't realize it at the time, this book was conceived in that moment.

This incident sensitized me to the intense marketing of these two drugs. Advertisements for them suddenly popped up everywhere. At first the ads seemed inappropriate, but quickly they claimed their place as normal fixtures of the American cultural landscape. The implication of the ads was that the (unspecified) superiority of the new drugs allowed people to enjoy activities that they had previously been unable to enjoy because of arthritic pain-though no such superiority had been found in any of the major research.

The marketing campaigns were certainly successful ...

Overdosed America
The Broken Promise of American Medicine
. Copyright © by John Abramson. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
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  • Anonymous

    Posted June 29, 2005

    Overdosed America--a SPECTACULAR BOOK!!!

    Overdosed America is a SPECTACULAR BOOK!!! Long overdue. I'm glad to see there's someone (Dr. Abramson) who is as skeptical of Big Pharma as I am. I quit pharmacy after 25 years because I was so disillusioned. I try to read every book I can find on Big Pharma. Overdosed America is the best. I found this book to be much more interesting than Marcia Angell's 'The Truth About the Drug Companies' and Jerry Avorn's 'Powerful Medicines.' This is the book that Big Pharma does not want you to read. This book should be required reading for every pharmacist in America. Unfortunately too many pharmacists are not interested in learning the truth. The media focuses on the high cost of prescription drugs. The more important issue is the questionable safety and effectiveness of too many of the products of the drug industry, and the fact that the most common diseases in advanced (i.e., industrialized or 'Western') societies can be prevented with non-drug measures. In America, we've got the best drug research that money can buy. Commercial interests have polluted the scientific basis of modern medicine. In the eyes of Big Pharma, 'reality' is a totally elastic concept. After 30 years of reading about cover-ups, deceptions, lies, manipulations of data, exaggerations of benefits, minimizations of risks, etc., I honestly don't know why I should believe anything that the pharmaceutical industry says. Overdosed America is the most important book I've read on medicine in the last 30 years, since Ivan Illich's 'Medical Nemesis: The Expropriation of Health.' (Pantheon, 1976) If you want to really understand pharmaceuticals, you need to read this book. In my opinion, there is no book that describes the real world of pharmaceuticals better than Overdosed America.

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  • Anonymous

    Posted December 19, 2004

    Why American Medicine Is Failing The Grade

    As a twenty year veteran of health journalism for national magazines, I have become increasingly suspicious that I can no longer trust leading medical journals, the FDA, or even the advice of my own doctors. I have been struggling to put together all the pieces of this puzzle--and despite massive reading on the subject it took John Abramson's erudite book to illuminate this immensely complicated issue for me. This is by far the best book I have ever read on this topic and should be essential reading for anyone who wants to understand why health care in this country costs so much and delivers so little. This book holds the answers to how the price of medical care could be slashed while quality of care significantly improved.

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  • Anonymous

    Posted October 6, 2004

    Great Book

    I was recommened his book by a fellow Physician (FP). Book was very engaging and interesting. It spells out a lot of things that we kind of know but don't want to believe. Must read book for physicians and Medical Students.

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