Overdosed America: The Broken Promise of American Medicine

Overdosed America: The Broken Promise of American Medicine

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by John Abramson

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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


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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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.

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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.

What People are saying about this

Herbert Benson
“A clear and concise explanation of how American medicine has gone astray...a must read for both patients and doctors.”
Eric Schlosser
“Before you see a doctor, you should read this book.”
Cheryl Richardson
“Essential for all those who want to intelligently reclaim responsibility for their own health.”
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.”

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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Overdosed America: The Broken Promise of American Medicine 5 out of 5 based on 0 ratings. 1 reviews.
Guest More than 1 year ago
In 'Overdosed America' Dr. John Abramson is mainly concerned with accuracy of information about prescription drugs and about medical devices and procedures in the United States. He shows how drug and device makers manipulate information to present their products favorably. Dr. Abramson leverages experience in public health policy, closely analyzing FDA fast-track approval of painkillers including Celebrex in 1998 and the now withdrawn Vioxx in 1999 'pages 23-38' and NIH revisions to cholesterol guidelines in 2001 'pages 129-148'. For those cases, Dr. Abramson provides detailed readings of published studies, showing how drug benefits were promoted and hazards minimized. * * * * * * * * * Dr. Abramson's most egregious example concerns hazards of Vioxx. A key report about Vioxx appeared November 23, 2000, in the New England Journal of Medicine, then as now edited by Dr. Jeffrey Drazen. It included information about potential hazards. An apparently authoritative review article about Vioxx and Celebrex appeared August 9, 2001, in the same journal, with updated hazard information. The latter article said increased incidence of cardiovascular events associated with Vioxx 'may reflect the play of chance.' From data published in the latter article Dr. Abramson found that the cardiovascular hazard from Vioxx was statistically significant, unlikely to represent chance occurrences. However, FDA action on the information was delayed until September, 2004, when Merck withdrew Vioxx from the market because of its cardiovascular hazard. On December 8, 2005, the New England Journal of Medicine published a belated 'Expression of Concern' saying authors of the November 23, 2000, article had omitted data which they then possessed, showing a greater incidence of cardiovascular events. * * * * * * * * * Writing before the 2005 disclosure, Dr. Abramson was incensed. Poring over information made available to the public by the FDA, he had already found that the FDA knew of a substantial cardiovascular hazard when Vioxx was approved. Members of the medical community had little access to this knowledge, unless willing to spend hours in background research as Dr. Abramson did, and the general public knew even less. Articles appearing in a major medical journal had promoted benefits of Vioxx and minimized hazards. Dr. Abramson reports pressure from his patients to prescribe Vioxx, inspired by advertising. He accuses 'commercial medical research' of 'rigging medical studies, misrepresenting...results' and 'withholding...findings' 'page xvii'. * * * * * * * * * Dr. Abramson's proposed remedy is a new federal agency 'to protect the public's interest in medical science' 'page 250'. It would set standards for 'medical research,' oversee development of 'clinical guidelines,' and initiate research 'when important scientific evidence was lacking.' While describing this new agency, Dr. Abramson does not say but appears to mean by 'medical research' mainly 'clinical trials' for prescription drugs and medical devices, not the basic research programs sponsored by the NIH and other agencies. The key power of the new agency over prescription drugs and medical devices would be certifications that clinical trials met its standards. * * * * * * * * * Dr. Abramson makes three more general recommendations to improve health care: a 'rebalanced' 'mix of physicians,' financial rewards to health care providers for 'improving the health' of their patients, and 'adequate, stable funding' of the FDA and NIH, replacing [prescription drug and medical device] 'industry money' 'pages 255-256'. Dr. Abramson does not provide guidance for making such changes. Instead he calls for 'courageous leadership' from someone else, inviting 'public hearings' investigating the Celebrex and Vioxx approval processes and investigating 'commercial bias in the 2001 update to the cholesterol guidelines.' * * * * * * * * * Despite the intensity of his investigations, Dr. Abramson does not seem t