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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.
|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|
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
Posted June 29, 2005
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.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted December 19, 2004
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.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted October 6, 2004
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.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.