Overdosed America: The Broken Promise of American Medicine

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public health policy, closely analyzing FDA fast-track approval of painkillers including Celebrex in 1998 and the now withdrawn Vioxx in 1999 (pages 23-38) and NIH revisions to cholesterol guidelines in 2001 (pages 129-148).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 to have spent comparable energy on his proposed remedies. Unlike many economists, he seems much impressed with the effectiveness of the Federal Reserve Board and wants to model his proposed agency after it. His proposed new agency appears similar in spirit to "science court," long advocated under different names by Dr. Arthur Kantrowitz, the physicist who founded Avco-Everett Research Laboratory in 1955 and later became a professor at Dartmouth. A key problem with "science court" was that it would duplicate functions of existing courts, with no clear way to resolve issues of jurisdiction. A key problem with Dr. Abramson's proposed agency is that it would duplicate functions already assigned to the FDA and the NIH, with no clear way to divide responsibilities. Since his core complaint is that those agencies failed, Dr. Abramson ought to have provided a history of how they came to fail and ought to have explored whether and how such failures could be remedied. Avoiding knowledge of failures invites their repetition, should Dr. Abramson's plan somehow be implemented. Dr. Abramson left his medical practice in 2002 to teach primary care at Harvard Medical School, where he wrote his book. In a January, 2005, interview published by Managed Care, he disclosed frustration trying to teach students to examine evidence critically: "it creates dissonance for them." He explains that "medical students want to learn indications, doses and side effects, because that's what they'll be graded on." Dr. Abramson is himself a primary care physician who did learn how to extract knowledge from muddled evidence and unwarranted conclusions. While his book does not try to deal with a wide range of problems in United States medicine, it is clear and convincing in describing the issues it takes on. "Overdosed America" can be most closely compared with "Powerful Medicines" by Dr. Jerry Avorn -- both books first published in late summer, 2004. Like Dr. Abramson, Dr. Avorn is an internist who teaches at Harvard Medical School. Unlike Dr. Abramson, Dr. Avorn has spent most of his career in academic medicine, currently heading a group of sixteen scientists and physicians called the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston. Dr. Avorn describes many of the same examples of problem drugs as Dr. Abramson -- including Vioxx, statins and hormone replacement therapy -- but his attitude is different. Where Dr. Abramson is sometimes incensed, Dr. Avorn is philosophical. Faced with probabilities of drug hazards, Dr. Abramson estimates the number of his patients who may suffer. Dr. Avorn says about such issues, "I don't intuit them well" (page 167). Instead, he says he has "developed a passable prosthetic sense of such things." A policy professional will probably find Dr. Avorn's explorations of prescription drug issues interesting and helpful. Most potential readers will find more insight and motivation in Dr. Abramson's book. It is a long read, travelling through territories likely to be unfamiliar. At the end of the journey, a persistent reader will understand a major problem affecting medical care in the United States and will have some sense of what needs to be done to deal with and correct it.

THis is a very well written book. I am a Primary Care Physician but have increasing concern about the enormous ammount of tablets patients are taking with limited evidence as to the benefits that they will get. An example would be the treating mild to moderate hypertension will reduce you risk of stroke by about a third. However what this means is that 125 men would need to be treated for 5 years to prevent one stroke. Now this may well be what you would choose, but it seems much less impressive does it not? We need to engage patients much more in the benfits and risks of preventative treatment. Remember that all pills have side effects. Finding out what is right for you may well just start here in this clear well written non polemical book. i could not recommend it more highly to patients or doctors alike. Both groups will be hugely informed by reading this book

“Probably as much as 75% of the medicine of sickness is unnecessary and its cost can be avoided.” – Dr. Ghislaine Lanctot, Author Of The Medical Mafia " One of the first duties of the physician is to educate the masses not to take medicine." - William Osler, M.D. This is my first glance at Dr. Abramson's work, and it did not disappoint. Overdo$ed America - The Broken Promise Of American Medicine By John Abramson M.D., does an exceptional job of eviscerating what the conventional medical establishment has been doing for an extremely long time: misrepresenting medical data at the expense of the American populace's health and well being. Abramson's foray into the heart of the medical establishment is something to behold. He does what nigh no one within his field does, or even the mainstream establishment does, which is hone in on duplicitous dealings of the Medical Industrial Complex in many ways. From manipulation of statistics, to scientific information that is highly inaccurate, no stone is unturned in this journey into the web of medical deception. The foray of Dr. Abramson is reminiscent of the work of Dr. Brogan in her landmark book, A Mind Of Your Own - The Truth About Depression, and Dr. Breggin in his phenomenal book Toxic Psychiatry. Both of those books destroy any semblance of reality within the psychiatric/medical establishment. Abramson did the same in respect to prescription drugs, and in an extraordinary way. The data collated within the doors of this book help individuals see the many intricacies that are unknown today. Not only did the FDA allow in 1981 the drug companies to change the direct-to-consumer [DTC] advertising rules, allowing the pharmaceuticals to advertise to people, but they also further loosened the restrictions in 1997, opening the flood gates. Therein began the normalization of advertising and drugs within the American landscape, which happens to be illegal in every country in the world except two: New Zealand and the United States. That fact should give incisive folks pause. Furthermore, the author delves into the pharmaceutical disasters that were Paxil, Celebrex, Vioxx, HRT, and more, but he doesn't stop there. Abramson also deconstructs how the supply side of medical care functions, and how it often increases costs, but not the benefits of health. Another noteworthy point is the fact that the cholesterol guidelines are delved into at length, as the author covers many of the issues plaguing those guidelines. There is a lot more covered by the author, and he also mentions some sensible solutions that can be carried out by individuals and the establishment. All in all, this is a top-down analysis of a great portion of the issues plaguing conventional medicine, and why American's health care costs have increased, but health has remained stagnant. If you care about your health, or that of a loved one, society, solutions, and/or the intricacies of medicine et al., consider this compulsory reading. The fact people don't know about this information is costing lives, in the hundreds of thousands, and that's not an exaggeration. Preventable medical mistakes are the third leading cause of death in the United States, at over 400,000 deaths a year. This book harpoons directly into the heart of the matter, and not knowing this information in the age of information is akin to willingly choosing ignorance when solutions are at hand in various modalities. Kindest Regards, Zy Marquiez TheBreakaway.wordpress.com P.S. If you wish to know others Doctors doing high quality work, please look into Dr. Ghislaine Lanctot, author of [The Medical Mafia], Dr. Kelly Broggan [author of A Mind Of Your Own - The Truth About Depression], Dr. Peter Breggin [author of Toxic Psychiatry], Dr. Russell Blaylock [author of Natural Strategies For Cancer Patients], Dr. Suzanne Humphries [author of Dissolving Illusions: Disease, Vaccines & The Forgotten History]. There are also many others. Those are just the ones first came to mind.

In the news this morning (November 20, 2004): The Associated Press reports that shares in pharmaceutical giants AstraZeneca PLC and GlaxoSmithKline PLC dropped after safety concerns over the anti-cholesterol drug, Crestor, and asthma drug, Serevent, were raised. For those who have read Dr. Abramson's book, Overdosed in America, safety concerns with Crestor will come as no surprise. Dr. Abramson has done a more than credible job of researching the current state of medical care in the United States (taking three years away from his private practice to do so). Examining the links between emphasis on lowering cholesterol and drug company profits is just one area of current American medical care he tackles. There are those who will argue that his common-sense approach to reducing health care costs while, at the same time, increasing American health, is too simple to be worthwhile. However, Dr. Abramson's recommendations are based on solid research findings. Sometimes, answers can be simple. Overdosed America is an important book backed up by Dr. Abramson's painstaking research. Read it to save your wealth. Read it to save your health. December Update: I am astonished to see such highly negative reviews of Overdosed America. Are these the same folk who would never buy an automobile or vacuum without checking Consumers' ratings? Surely, they have failed to read the book carefully or they could not suggest that much valuable research will be lost if we become actively involved in our own medicine and related pharmaceuticals instead of passive consumers of whatever latest pill that's being pushed. Surely, they have failed to read carefully if they believe that the studies "proving" the safety of pharmaceutical are always fully and accurately reported. My only beef with Dr. Abramson is that he is, in my opinion, far too lenient on doctors. While I realize that they are already overworked, I think that prescribing pharmaceuticals about which they know only what is given them by drug company representatives is reprehensible. We all have our part to play to keep medical costs and medical errors under control. To my mind the responsbility falls on doctors just as much as consumers. Nonetheless, this book is far more than a sensationalism of the problems with current pharmaceuticals. The information it contains could save a life - your life or someone you love! Phyllis Staff, Ph.D. author, "How to Find Great Senior Housing" and "128 Ways to Prevent Alzheimer's and Other Dementias" P.S. Added October 18, 2006: Events of the last two years have only buttressed the premise of Abramson's book. This is a "must-read" for anyone concerned about health and well-being. Don't miss it!

Dr. Abramson writes how prescription drugs are being pushed to fix a lot of problems that could be solved or at least abated with lifestyle changes like exercise, diet, eliminating tobacco, and moderate alcohol use. Type 2 Diabetes, heart disease, high blood pressure, osteoporosis, strokes, depression, obesity, and even some cancers can be effected much more positively with exercise and diet than with expensive and marginally helpful drugs. The book shows why statin drugs aren't for everybody, Celebrex and Vioxx are no better than naproxen only much more expensive, osteoporosis drugs can cause more problems than they help in some patients, antidepressants (Prozac, Zoloft, Paxil, etc.) are no more effective than placebos and in fact cause more suicides, cheap water pills work as well as expensive diuretics for blood pressure control, there is still much research to be done on cholesterol (total, LDL, HDL) control, and why we need to stop drug companies from contributing to FDA and NIH (fox in the henhouse problem). He describes how the drug companies are increasingly influential in spinning drug trials to their benefit or burying results not to their benefit, how doctors can't trust medical journal reports because of manipulation of data or wholesale ignoring of important facts, how doctors are pressured by time and patient demands to prescribe the latest advertised wonder med that is expensive and questionably effective. His goal is that patients realize how important a smaller and better diet along with a couple hours of exercise a week can have a huge impact on their quality of life and fewer drugs. The problem is that most people know what they need to do but really enjoy eating and hate to exercise - day to day living, and changing habits are much harder to accomplish than just knowing it.