Powerful Medicines

Dibawah ini ada suatu 'book review' dari Australia yang luar biasa bunyinya:
Book review
(Aust Prescr 2005;28:101)
Powerful medicines: the benefits, risks and costs of prescription drugs.Avorn J.
New York: Alfred A. Knopf; 2004.
448 pages. Price approx. $57

John Marley, Pro Vice-Chancellor, Faculty of Health, University of Newcastle, Newcastle, NSW
Reading this book is like sitting on the side of a hill watching a faulty train full of happy
passengers hurtling towards inevitable catastrophe and being powerless to stop it happening. In
fact it's like watching wreck after wreck take place. In these cases the trains are manufactured by
the pharmaceutical industry, the passengers are the trusting patients and the drivers are the
prescribers who appear blind to the possibility that there could be any danger ahead. The
controllers and signallers are the regulatory authorities who may be in the pay of the train's
manufacturers or dominated by politicians.
The book starts with examples of recent drug catastrophes. It lays out how, particularly in the
USA, the reach of the pharmaceutical industry is everywhere. The authorities, who should be the
guardians of drug safety, are subject to a Congress and Senators in the pay of the industry and
they are guided by professional experts who should be objective, but instead are recipients of
payments and other inducements to support products and launder data. Although we all suspect
this to be the case, the true extent of it is almost beyond comprehension.
The book is a very balanced text as would be expected when the author is one of the world's
foremost pharmacoepidemiologists. It is not all anti-drug or anti-industry, there are sections on
benefits as well as risks and costs. There are sections on policy and on how information about
drugs is collected and used. There is an excellent discussion about the choices society has to
make about how to get the best value from health dollars.
The book has, of course, a heavy focus on the USA. While this may make it of less interest to
readers outside that country, there are many similarities with events here that readers will
recognise. For example, the infiltration of the research agenda by the pharmaceutical industry as
public research funds become more scarce, and the hijacking of postgraduate education in the
same way. We also have medical experts, 'key opinion leaders', who have been subtly bought by
the industry.
My one criticism is the use of American trade names even though generic names are usually, but
inconsistently, given. Although some generic names are cumbersome and not easily recognised,
the international reader will not recognise many of the American names.
The book makes complex topics easily comprehensible. What makes the book so readable,
beyond the voyeuristic fascination of watching tragedy after tragedy unfold, is Avorn's sharp
humour. For example, '... anti-Parkinson drugs are a rough crowd to invite across your bloodbrain
barrier if you don't have to'.
Jerry Avorn is a world expert and also a brave crusader. Anyone who ever prescribes, dispenses
or takes a medication should pause before they do so to read this book. They may make a
different choice as a result.
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