Rethinking Medications: Truth, Power, and the Drugs You Take

by Jerry Avorn

A leading medical expert explains why many medications Americans take are poorly effective, overpriced, or pose unwarranted risks—and what we can do to fix that.

Groundbreaking research has given us many remarkable new medications, but the American drug regulation process, once the envy of the world, is being seriously compromised. Under pressure from the pharmaceutical industry and Congress, the FDA has been lowering its approval standards and allowing poorly effective or risky drugs to enter the market—at the same time that our prescription prices have become the highest in the world. In Rethinking Medications, Dr. Avorn explains how we got here and what we can do to ensure that our medicines are reliably effective, safe, and affordable.

Part of the problem, Dr. Avorn points out, is the power of pharma’s biggest-in-Washington lobbying clout, which influences members of Congress from both parties. Drug companies’ considerable leverage is extended by FDA’s growing dependence on fees the industry pays to get its drugs approved. Meanwhile, our highest-anywhere drug prices put needed medications beyond the reach of many patients, adding pressure to the funding of medical care for everyone. The increasingly profit-driven US health care system shapes the way doctors prescribe medications—sometimes to the detriment of patients.

Based on his decades of practice and research at Harvard Medical School and his role at the center of many of these controversies, Dr. Avorn presents compelling clinical illustrations of these issues across the medical from cancer drugs to opioids, from treatments for rare diseases to psychedelics. Throughout, he offers practical steps that consumers, policymakers, and practitioners can take to fix these problems.

Genres: Science, Nonfiction, Audiobook, Medicine, Medical

512 pages, Hardcover

First published April 22, 2025

Reviews

[Lauren Pumpkin · Rating 1 out of 5]

The fastest way to ruin a well-researched book is to introduce bias.

[Leah · Rating 4 out of 5]

Intriguing. I knew the American healthcare industry and pharmaceutical companies had deep pockets and a wide reaching influence. The various cases and examples built a compelling case for change. There is no secret of the author’s political views in this, but I do admire his dedication to his convictions as portrayed in this book. I certainly have much to think about after reading this book.

Readers who want a glimpse at how the US health landscape operates will probably enjoy reading this as long as they don’t mind sifting through some of the stronger opinions which frankly favor neither side, just one slightly more than the other. It goes into a handful of major court cases, large public health crises, well-known expensive medicines, policies, and the relationships between government, pharmaceutical companies, and academia. While I liked the book’s information and thought much of it is important for Americans to know about their healthcare system, I’m not quite certain what the best path forward is because it sounds like the average person is in a no-win situation. Government regulations would be a possible answer - when they actually work, are enforceable, and aren’t subject to a four-or eight-year cycle. Advocacy seems to get us into trouble as much as it gets us out of it. Though from another angle, perhaps that’s the point: to let us decide for ourselves how we choose to obtain information and what we will do with it.

4 stars. It is written in an accessible way, with a couple places that use more legal and academic language. Fortunately, the author intentionally tried to explain so I didn’t spend too much time confused at what was happening. Would definitely recommend to anyone who truly wants to know more about how the U.S. healthcare system ended up where it is today.

[Irene · Rating 3 out of 5]

This started out as a 5-star read for me, but about halfway through it lost its way. Instead of focusing on the pharmaceutical industry and its issues, it turned into a memoir of the author's medical career. Then the author's political views took over, and factual objectivity went out the window in favor of weasel words such as "likely," "anticipated," "expected," etc. Also, after describing the failures of the FDA and other consumer-protection agencies in the first half of the book, the solutions presented involved more government agencies and more money and more studies and more regulation--all stuff he showed didn't work in the first half of the book. I definitely recommend reading the first half of the book. Unfortunately, the second half dragged its rating down to 3 stars for me.

[Maya Dinero · Rating 5 out of 5]

This book was such a good time. I learned a ton, but I also laughed out loud way more often than I expected. Avorn’s fondness for puns and little bits of wordplay gave the whole thing a charm that most books on medication safety could not dream of.

The blend of research, academic dynamics, and personal anecdotes worked perfectly for me. It made the content feel human and readable. Also, I will admit I enjoy a touch of academic drama, so those moments definitely helped.

People keep saying the book is political. Honestly, if he worked in this field for over sixty years and somehow avoided forming policy opinions, that would be concerning. His insights are grounded in evidence, and of course they intersect with politics because medicine and policy are linked by definition.

[Linda · Rating 1 out of 5]

Author's liberal leanings clearly come through, making the conclusions he puts forth biased and in my opinion wrong. Admittedly, I did not make it beyond the first few chapters, however based upon all my studies and research since COVID and my 25 year career in Big Pharma, I have as much or more credibility than he does. Better titles on the topic would be by John Abramson, MD, "Overdosed America" and "Sickening". Though my VERY favorite is "Follow the Science: How Big Pharma Misleads, Obscures, and Prevails"by Sharyl Attkisson.

[Joe Utecht · Rating 5 out of 5]

I’m in the pharmaceutical business and this book was eye opening. If you’re curious what’s wrong with our healthcare and how to fix it, this book is a must read. Very president r should be forced to read this book.

[Darlene Torday]

I marked this as read but only read chapters that interested me so cannot give an overall fair rating for this book/author.

[Carol · Rating 3 out of 5]

Interesting but much too detailed to be an enjoyable read.