Overdosed America: The Broken Promise of American Medicine

by John Abramson

“ Overdosed Americ a reveals the greed and corruption that drive health care costs skyward and now threaten the public health. Before you see a doctor, you should read this book.”  —Eric Schlosser, author of Fast Food Nation 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 For twenty years, John Abramson, M.D., cared for patients of all ages in a small town north of Boston. But increasingly his role as family doctor was undermined as pressure mounted to use the latest drugs and high-tech solutions for nearly every problem. Drawing on his background in statistics and health policy research, he began to investigate the radical changes that were quietly taking place in American medicine. At the heart of the crisis, he found, lies the changed purpose of medical knowledge—from seeking to optimize health to searching for the greatest profits. The lack of transparency that has become normal in commercially sponsored medical research now taints the scientific evidence published in even our most prestigious medical journals. And unlike the recent scandals in other industries that robbed Americans of money and jobs, this one is undermining our health. Commercial distortion pervades the information that doctors rely upon to guide the prevention and treatment of common health problems, from heart disease to stroke, osteoporosis, diabetes, and osteoarthritis. The good news, as Dr. Abramson explains, is that the real scientific evidence shows that many of the things that you can do to protect and preserve your own health are far more effective than what the drug companies' top-selling products can do for you—which is why the drug companies work so hard to keep this information under wraps. In what is sure to be one of the most important and eye-opening books you or your doctor will ever read, John Abramson offers conclusive evidence that American medicine has broken its promise to best improve our health and is squandering more than $500 billion each year in the process.

Genres: Nonfiction, Health, Medicine, Science, Medical, Health Care, History

334 pages, Paperback

First published September 21, 2004

Reviews

[Karen · Rating 4 out of 5]

this is a must-read, though it is very dry. it basically explains how the drug companies are profiting by manipulating the medical industry. the pills in your grandma's medicine cabinet may have been prescribed because a 20-something drug company rep took her doc out to a fancy schmancy dinner, peddling the skewed research data for the drug. doc takes the bait, writes grandma the script for new drug x, and (all too often) drug x is pulled from the market due to some deadly complication.

how many other countries allow direct customer advertizing of prescription medication? count the commercials next time you watch a tv program.

most of the studies done on the new pharmaceuticals are actually sponsored by the drug companies that produce them. do you think the negative studies are actually published?

the studies that are published in medical journals are long winded, and docs usually don't read them, let alone check the data. the author of this book did, and it inspired him to take a stand.

most of the new drugs developed are no better than the old standbys. the difference? more $$ to be made.

read it for the sake of you and your family.

[Margaret · Rating 5 out of 5]

This book was recommended to me by an openminded colleague. It was fascinating. If you believe that your doctors are prescribing drugs like candy...and think maybe there is something wrong with this picture...read this. It confirmed to me much of what I thought about all those statins being "miracle" drugs. I recommeded it for my graduate students to read. If more people and health practitioners would read books like this, they would become much more empowered with regard to taking charge of their health.

[Anna · Rating 5 out of 5]

I grew up under the belief that I lived in the country with the GREATEST health care system in the world, that "all-knowing" doctors know what's best for me, that prescription drugs are good for my health (and can fix any ailment), and that America's "top-notch" technology and medical “advancement” is for our benefit. Most Americans hold this same belief. Would you agree? Well, I have news for you: You've been duped!

Educate yourself by reading this book.

EVERYONE would benefit from reading "Overdosed America." This book sheds some great light on understanding the true broken state of America's healthcare system, and specifically how commercialized and money-driven it has become; how our nation has come to the unrealistic belief that good health is primarily the product of medical science rather than the consequence of a healthy lifestyle, how our perception of medicine has been masterfully manipulated by the monster pharmaceutical companies' BILLION dollar marketing efforts, and how healthcare and research is now more focused on improving the drug companies' sales rather than improving patients' health and comfort (doing us more harm than good, with falsifying data and hiding harmful side-effects becoming sickeningly common).

This is truly an eye-opening book, and I recommend it to everyone!

[Zy Marquiez · Rating 5 out of 5]

“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.

[Kathleen LePine · Rating 4 out of 5]

I started reading this book as an assignment for my ethics course in pharmacy school, and ended up really questioning the medical world we know...or THINK we know. This book was written by a family practice physician who retired from his job to write this because he was bound and determined to uncover all the crap that goes on today with drug companies, drug reps, and how the American people are responding. There are a few parts that I had a hard time agreeing with because, being in pharmacy school, I've been taught about drug studies and read hundreds of papers on drug trials and know how they are conducted and how the data is presented. However, this book really makes you think.

[Marcus Goncalves · Rating 4 out of 5]

This book is outdated (2008), still, an excellent and well researched work. Indeed, mostly of the medicine of sickness is unnecessary and its cost could be significantly avoided. It’s a daring work showing the lobbing and abuses of the pharmaceutical industry, written by a physician.

[Quratulain · Rating 5 out of 5]

The overwhelming power that drug and other medical industries now wield over American politics , science, and health care has created an imbalance between corporate goals and public interest that is no longer self-correcting. It has become resistant to correction.”
Many diseases share the same cause and that cause is often rooted in lifestyle choices such as poor diet, smoking, and lack of exercise, environmental factors or economic status.
Just knowing these recommendations is not enough. Making positive changes is often complicated by personal inertia and social, economic, and environmental factors beyond the control of individuals and even whole communities.”
The cultural environment in which our lives unfold also plays a major role in determining our health.”
The goal of performing rigorous medical studies is often replaced by the goal of creating the perception that rigorous medical studies call for increased use of sponsors products.”
The primary problem is not that the escalating cost but the low quality of medical care that results when those with health insurance receive too much of the wrong kind of care and those without health insurance receive too little of the care that is necessary.”
Health policy experts, doctors, and the public are unable to discern the commercial distortions of the medical knowledge upon which they rely. Quality of care is now defined largely in ways that best serve the financial interests of drug and other medical industries rather than the health needs of the American people.”
The inability of the market to serve Improve care sufficiently on its own and to increase the value that Americans receive for their dollars is an indication of private market failure.
The areas of the country that have higher concentrations of specialist physicians have higher health care costs and worse health care outcomes.”
Though successful in the short term, these biomedical interventions undermine the natural motivation provided by patients symptoms to make the real and lasting changes that would lead to sustained improvement in the quality of their lives.”
Four most common cancers: age adjusted rates are all higher in the developed countries and increase when diets change or people move from less to more developed countries.”
Nurse Health Study in 2001: 91% of the risk of developing type 2 diabetes can be attributed to lifestyle factors such as being overweight , getting insufficient exercise, having a poor diet, and smoking.”
When corporate partners fund the flow of information, the message is likely to accentuate strategies that are in their interest and downplay those that are not.”
People whose symptoms were relieved by drug treatment were less motivated to learn how to change the dysfunctional patterns of reaction and interaction that had given rise to their symptoms in the first place.”
Physical fitness, smoking cessation, and a healthy diet trump nearly every medical intervention as the best way to keep coronary heart disease at bay.”
The Lyon Diet Heart Study show that the Mediterranean diet was much more effective at reducing the risk of recurrent heart disease than the statins, but the decrease in risk came without lowering cholesterol levels.”
It is not uncommon to hear doctors say that we should just put statins in the water.”
When alteplase is administered to 100 properly selected patients within 3 hours of the onset of stroke symptoms, 12 more patients have minimal or no disability three months later.
When bone mass starts to decline in women, trabecular bone is lost more quickly than cortical bone. Once the architecture of these internal struts is lost, there is no structure left onto which calcium can be added. The new bone, formed as a result of taking osteoporosis drugs is then formed primarily on the outer part of the bone, the cortical bone. This increases the score on the BMD test but does not necessarily contribute proportionately to fracture resistance.”
It is much more important to know what sort of patient has a disease than what sort of disease a patient has.” Sir William Osler
The challenge to doctors is to learn as much as possible abo it the scientific-technological skills of medicine, while maintaining the wisdom to integrate these skills into what are fundamentally moral and interpersonal relationships with their patients.”
Half of all deaths that occurred in the US in 2000 could be attributed to…largely preventable behaviors and exposures. Another 6% of deaths were attritutable to poverty.
Significant and lasting change in behavior often requires changing the deep assumptions that sustain the paradigm of self.”
Doctors provide appropriate counseling only 18% of the time.”
Just as individuals are made up of multiple levels of function, they are also embedded in these larger contexts that play an important role in their sense of identity, personal beliefs, and sources of meaning— all of which plays a large role in determining their health behaviors.”
Abraham Flexners good intentions laid the groundwork for the specialty—and research-dominated system of medical education that still stands.”
More than half of people who go through coronary artery bypass surgery experience a significant decrease in mental capacity postoperatively, and the risk is even higher for older patients.”
The reason for the greater number of cardiac procedures being done in the US was monetary remuneration to the facilities and physicians.”
In a health care system lacking effective health technology assessment and limits on spending, paying doctors and hospitals more for doing more, and disconnecting patients costs from health care value , supply-sensitive services are sure to be overused.”
The reductionist approach doesn’t always lead to the most effective medical care.”
About 5 out of every 6 cases of heart disease that developed among the nurses could be attributed to an unhealthy lifestyle.”
Once an adequate amount of care is being provided, more care is worse care.”
80% of people older than 50 without any back symptoms have at least one bulging disk in their lumbar spine on MRI.
The saddest aspect of our excess spending occurs with end-of-life care, when people are most vulnerable and excess care can cause the most suffering.”
Understand, diagnose, and treat if possible the local body part that is causing symptoms. This is the essence of the biomedical model.”
Most men with CHD should take statins.
Studies show that statins probably lower the risk of recurrent CHD in women with CHD but do not appear to lower their overall mortality rate.”
Becoming well-informed and reclaiming personal responsibility are the best antidote to a fundamentally flawed system.”
The medical industry has finely honed its ability to mold public knowledge about the best medical care…its most obvious technique is using drug ads…more insidious are the public relations campaigns that translate into seemingly unbiased news stories and nonprofit public awareness messages.”
Advertising serves not so much to advertise products as to promote consumption as a way of life.” Christopher Lasch
Only 13% of drug ads in magazines used data to describe drug benefits; the remaining 87% relied on vague statements. Not a single ad in the study mentioned the cost of the drug.
We want to identify the emotions we can tap into to get that consumer to take the desired course of action. If you can’t find that basic insight, you might as well forget everything else. Ernestine McCarren
When for-profit money gets cycled through nonprofit organizations, especially trusted service and professional organizations, the commercial goals of the donors become nearly invisible.””
The net result of treating people with moderate risk of developing coronary artery disease with a statin was simply to trade coronary heart disease for other serious diseases, with no improvement in health.”
Doctors tend to believe that they are immune to drug coolant influence. They don’t realize that at every step of the way, at every moment of information transfer, and with nearly unimaginable skill, the medical industry insinuates itself into their medical decision making.”
13 year delay in publication of funding that class I antiarrythmic drugs increase risk of death. 20,000-75,000 lives lost each year in the 1980s in the US alone from inappropriate administration of class I antiarrhythmic drugs.
The actual rate of death from suicide is higher in patients who take the new antidepressants than in those who take older tricyclics (amytriptyline).
Food, flattery, and friendship are all powerful tools of persuasion, particularly when combined.”
Doctor-medical-industrial complex: compromised medical journals, publication bias(negative reports not published), commercialized CME, paying doctors to prescribe, medical reps, industry establishing medical guidelines for doctors.
Most of the doctors who do commit malpractice are not sued, and most of the lawsuits brought against doctors are about situations in which malpractice was not committed.”
The transformation of medical knowledge from a public good, measured by its potential to improve our health, into a commodity, measured by its commercial value.”
In the 1970s, government funding declined so that by 1990 almost 2/3 of research fund requests from NIH were declined. Between 1977- 1990, drug company expenditures on research and development increased 6x and much of the money went to support university-based clinical research. By 2000, only 1/3 of clinical trials were being done in universities and academic centers and the rest were being done by for-profit research companies that were paid directly by the drug companies.”
Commercial researchers: tinker with dosages, compare something with nothing, study the wrong patient population, end unfavorable studies early, keep the real data hidden, use ghostwriters and rubber-stamp experts, do PR damage control.
I wondered if her oncologist thought of death as the final defeat against which all-out war must be waged, even though there was no real hope of winning.”
We were all emboldened by our implicit trust in the efficacy of the most advanced medical care that was to be provided in a top-notch academic medical center. Most Americans share this great faith in the superiority of American medicine.”
What was being presented by the most trustworthy sources as the best medicine was often quite the opposite, and that the commercial distortion of our medical knowledge had become a major impediment to good medical care.”
My patients were looking to pills to keep them well instead of making changes in their lives that evidence showed to be far more beneficial .

[Ali · Rating 5 out of 5]

Eye opening. A must for all healthcare consumers.

We bought this book after my husband attended a mind-body institute sponsored through Harvard. Dr. John Abramson was one of the speakers who seriously enlightened my physician science minded husband about the politics behind "research." The internal story is Dr. Abramson took time off of his practice to really study the published studies in the BIG medical journals (JAMA, Annals of Internal Medicine, NEJM, etc.) Not surprising, much of the "research" studies are sponsored by the drug companies themselves with the primary investigators receiving large endowments for spinning their research. Not only that but the journals are largely sponsored through the advertising dollars of the very drugs published in their "studies." He dug deeper and asked for the "irrelevant data" that the pharm companies deemed "inconclusive." He's been waiting for the studies now for over 4 years, BTW. Since the budget cuts to the NIH in the 1970's, much of the "research" has been shifted from the academic university settings to for-profit research centers sponsored by the corporations. The very journal articles that our doctors are required to keep abreast and treat as their bibles of what is current are biased beyond belief all for the profit of the pharm companies.

It debunked a lot of myths like how statins are good for everyone as a preventative. (Not one study even looked at females, by the way). It also mentioned the hip fracture calcium meds. Did you ever wonder why all of a sudden hip fractures became so lethal in our culture's media in the 1990's? The meds to help prevent hip fractures actually only help 1:1000 women but the sales are more per year than just an average rehab from one hip fracture. I also learned a lot about hormone replacement therapy. Think about how all of a sudden these direct advertisements popped up on tv around 1997 to "ask your doctor about...." It explains the politics and how the drugs like Claritin were touted for the non-drowsy side effects (20 mg) only because they didn't use the effective dose (40 mg) that WOULD cause you to become drowsy. BTW, it tested just as effective as the placebo.

My only criticism is that the author clearly has a passion for data, statistics, and information, so as a lay reader, you need to be patient. (No pun intended)

[Heather Clapp · Rating 5 out of 5]

I always love a book that lets me know that some of my cynical inclinations are actually correct. It dawned on me as a marketing student in college that pharmacudecal companies are probably like any other business that needs to provide a decent ROI to investors or else they will go out of business, AND that in order to do this they must maximize profits. How does any company do such a thing? They focus on profitable activities (drugs that appeal to those with money or insurance), encouraging repeat business (drugs that treat rather than heal), and expanding market share (if the population feels healthy convince them they are sick). Well Abramson has given me the gift of a book to share when people say I'm crazy for doubting the safety and efficacy of most new drugs.

[Mike · Rating 4 out of 5]

How the times have changed since Salk couldn't understand the point to copyrighting the polio vaccine. Drug companies will rig trials with people not afflicted with the disease supposedly cured. If the trial starts to prove something that will hurt a drug's sales, it is cut off and spun... even if that drug will cause more harm / death than cure.

We Americans are to blame always demanding easy fixes. Living a healthy life is better than all the statins and heart procedure advancements we could ever want. But, prevention isn't nearly as sexy as daring, invasive surgery or drugs.

[Kelly · Rating 3 out of 5]

Some of his more important points get bogged down in that mire of a middle section. He had my attention at the beginning, then lost it during the middle few chapters that felt duplicative and without aim. Had that section been pared down, it would've been more memorable.

[Jamie Fuller · Rating 5 out of 5]

This book has a lot to recommend it, but possibly it's best feature (in my opinion) is the comprehensive breakdown the author offers on two subjects:
- Physician education
- Pharmaceutical research

Abramson does a top-notch job of explaining how problems and corruption embedded in America's physician training processes and institutions directly contribute(d) to the disastrous system we currently have, and how they directly limit doctors' ability to learn about and get on board with newer, better science and practices.

He also gives one of the best lay-person oriented breakdowns I've seen about the various ways drug companies rig medical studies to ensure that only the results they want get recorded, recognized, and referenced... and everything else gets buried.

The author also has some very insightful things to say about the deterioration of the doctor-patient relationship, the causes, and the costs. This isn't a hard a read, and it's definitely worth everyone's time.

[László · Rating 5 out of 5]

One of the most significant books I ever read. Be careful with it. Reading reveals what you were guessing for a long time but no one actually told you. Also, unfortunately this doesn't limit only to America.
If you were Neo this would be the moment when you just swallowed the red pill. "After this there is no turning back. You take the blue pill, the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland and I show you how deep the rabbit hole goes. Remember, all I’m offering is the truth, nothing more"

[Karen · Rating 5 out of 5]

I highly recommend reading the first version. The whole book contains so many interesting says that capitalism undermines appropriate medical intervention. The second version added a section sensationalism the pharmaceutical companies as particularly evil, in a clear attempt to just sell books. Anyone looking at how hospitals price and use testing to fill garage would find them just as egregious.

[BethK · Rating 4 out of 5]

Great book. Explains the problem we have with all of these (expensive) medications, which do not perform as advertised.

[brian tanabe · Rating 5 out of 5]

Eye-opening account of one facet of the medical/pharmaceutical world.

[Berke Sahbazoglu · Rating 5 out of 5]

A book all Americans should read to see disconnect between healthcare spending and health outcomes in the US.

[Ben Nimphie · Rating 5 out of 5]

A must-read for anyone interested in optimizing their health and looking critically at the capture of the healthcare industry by pharmaceutical companies.

[Fos · Rating 2 out of 5]

Paperback
Written in 2004, currently 2023.
Too out of date, before Bioidentical HRT, which is topical and safe in a combo lotion.
-skip, find something more up 2 date

[Andrew · Rating 5 out of 5]

This book was quite an eye-opener. As a member of the medical community, I have noticed how much we revere uptodate and accessmedicine and epocrates as the pinnacles of medical knowledge. We're so trained to accept guidelines at face value and assume that they follow the evidence. Abramson details how many of these guidelines are written by "experts" with financial links to pharmaceutical companies, leading to deliberate misinterpretation of the evidence in a manner that maximizes profit rather than health. There are many other problems in the American healthcare system (this book ends up discussing many of them), but one of the central tenets of this book is that the drive towards specialization and protection of specialist/pharmaceutical interests has compromised American health, which is the cause of the US healthcare paradox - most expensive system for sub-par overall medical care.

Many facts that I learned:
1. In the randomized clinical trials (RCTs) for statin Pravachol, the risk of stroke was cut by 19%, but this is a relative risk reduction. In actuality, the abs risk reduction was only 0.8%, meaning that over 100 patients need to be treated (NNT - good interventions have NNT<10) over 6 years with Pravachol daily to prevent ONE stroke. Abramson calculated that with this calculation, it costs $1.2 million to prevent that one stroke. When I researched this further, I found a fascinating ACP journal club article summarizing 14 RCTs that found the NNT over 5 years for statins to prevent:
- one coronary event: 45
- one vascular event: 27
- one CV death: 121
- any death: 87
That's a really high NNT considering how we prescribe statins like candy.

2. People say that our medical system is so expensive (our prescription drugs are 70% more expensive than in Canada and W. Europe) b/c America foots a disproportionate share of medical/pharmaceutical innovation. But the fact is that we did not develop more drugs per capita than W. Europe or Japan and from 1995 to 2000, only 13% of new drugs actually contained new ingredients (ie. development of Nexium is not a new drug compared to Prilosec).

3. Since 1900, American lifespan has gone extended 30 years. Of the 30:
- 25 yrs are attributable to advances in public health (ie. food, water, housing, nutrition, vaccinations, inc quality of life).
- 18-19 months due to preventative care (ie. cancer screening, smoking cessation, aspirin to prevent heart attacks).
- 44-45 months due to medical care for illness (ie. heart attacks, trauma, cancer, pneumonia, appendicitis).

4. Health policy experts recommend that 42-50% of doctors in US should be primary care MDs, but only 31% are current PCPs (69% are specialists). In 1998, only 36% indicated primary care as 1st choice for residency. In 2002, it became 21.5%.

5. One estimate says that 30-33% of Medicare expenditures can be saved nationally without compromising quality of healthcare.

6. A Rand Corporation study published in NEJM in 2003 shows that doctors provide appropriate counseling (ie. diet and exercise) to patients only 18% of the time.

7. We in the medical field always tell elderly women to worry about osteoporosis due to worry of hip fracture, but in the JAMA 1998 study for Fosamax, the relative risk reduction was 60%. That sound phenomenal, but the risk of hip fracture only declined from 0.5% in untreated women to 0.2% in Fosamax-treated women. That means that 81 women need to take Fosamax for 4.2 years to prevent one hip fracture. If worried about falls, interventions such as a fall-ther prevention program reduced hip fracture from 6.1% in nursing home residents to 1.6%. Other cheaper interventions, such as strength training and calcium and vit D supplementation get no attention.

8. 2002 American Heart Association Recipe for healthy living:
a. Avoid tobacco
b. Exercise at least 30 minutes on most days
c. Consume alcohol in moderation
d. Eat a healthy diet
- chicken, fish, and vegetable proteins rather than red meat
- at least a pound of vegetables and fruits a day
- limit salt to less than 1tsp/day
- cut down on sgar
- use vegetable oils for cooking
- minimize intake of saturated fats and cholesterol
- consume <2% of caories in transfat
e. Keep BMI <25
f. Use seatbelts and bike helmets; don't drink and drive
g. Don't engage in unsafe sex

[Jon · Rating 4 out of 5]

This book is a real eye opener on how commercial interests have superceded the health interests of people by being deeply imbedded in at all levels, including the FDA, peered reviewed journals, our politicians, etc. The author goes over the best preventions for our health (exercise, good diet with lots of vegetables and fruit, and cessation of smoking are his main points). He goes over the minute effect of several drugs (and their bad effects on health) including statin drugs. He shows how statin drugs don't work nearly as well as exercise and have almost no positive effect on stopping heart disease.

The reason I didn't give the book 5 stars is due to the last section where the author proposes his plan to fix the health care problem and promotes universal health care. He knocks the republicans quite a bit in the book but if he saw what the democrats were doing now he would probably knock them too. He quotes Health Affairs "The inability of the health care industry to improve care sufficiently on its own and to increase the value that Americans receive for their dollars is an indication of private market failure." He also states that a new medical board free of political interference needs to be created like the Federal Reserve Board.

His assumptions are erroneous for several reasons. He assumes the federal reserve is unbiased and that they serve the public well (since they have created worse market imbalances and follow the Keynesian (the school of inflate the currency in order to have bubble on top of bubble on top of bubble) school of thought it baffles me how he thinks the medical community needs something like the fed). We also are seeing that the fed is very biased in its policies and not accountable to anyone (unless congress somehow gets to audit them). This also creates a public that assumes the federal entity is always right and they don't question them (as they do the drug makers).

The author assumes that we have a free market (from the quote above). What we have is a government-sponsored-monopoly market that has a pseudo-market inside the monopoly. The federal government required certification of doctors in the late 1800s which caused the Flexner Report (the review of the medical schools) which caused closing of many schools and burdensome regulation of the schools (hence the closing/merging of more than half the medical schools). Later FDR forced company pay caps which caused companies to offer insurance to its employees which has led to the mess we have today. Lessons learned, keep government out of our day-to-day lives and then we will have more choices and more people will have access to care and we won't have government sponsored monopolies.

See the following articles for a more in depth view of true health care reform:

http://www.cato.org/pub_display.php?p...
http://stefanmikarlsson.blogspot.com/...
http://mises.org/story/3233
http://mises.org/freemarket_detail.as...
http://mises.org/story/3429

From the introduction: "tests unlikely to improve patient care were being routinely ordered and expensive drugs that had not been shown to beny more effective or safer than the older drugs they were replacing were being routinely prescribed....What I found over the next two and a half years of 'researching the research' is a scandal in medical science that is at least the equivalent of any of the recent corporate scandals that have shaken Americans' confidence in the integrity of the corporate and financial worlds. Rigging medical studies, misrepresenting reasearch results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor have all become the accepted norm in comercially sponsored medical research....to insure its translation into medical practice-there is a complex web of corporate influence that includes diempowered regulatory agencies, commercially sponsored medical education, brilliant advertising, expensive public relations campaigns, and manipulation of free media coverage....[The corruption:] is now commonplace at even the most trusted of American health institutions, the National Institutes of Health and the Food and Drug Adminstration."

[Malin Friess · Rating 4 out of 5]

For 2 decades Dr. Abramson a primary care physician cared for patients in a small town north of Boston. But he felt that is ability to practice medicine was undermined as pressure mounted to use the newest drugs (often more expensive) and the newest technologies. He quit practice and with his background in stats and health policy wrote this book; 'Overdosed America: The Broken Promise of American Medicine.

Abramson contends that even the most well respected medical journals are not immune from the power lobbying power of drug companies:

-JAMA study in 2003 showed that studies with commerical sponsorship are 5.3 times as likely to recommend the new drug than those without commercial sponsorship.
-70% of all CME are sponsored by drug manufacturers spending on average $1500 per doctor
- there is 1 full time drug rep for every 4 office based doctors. The number of drug reps has tripled the past 3 years. Drug companies spen 4.7 billion visiting the 490,000 offices each year

Abramson is a strong believer is less medicine (that we often have 'drugs in search of a disease.) He feels that menopause was medicalized. 20 million women took HRT to prevent symptoms of menopause also believing it would protect their heart, decrease risk of Alzheimer, prevent tooth loss and diabetes, strengthen their bones, and prevent incontinence. These women were wealthier and more likely to have graduated from college. In the end HRT increased one's risk for breast cancer by 26% (too high a price to pay for the heart benefit). 100,000 unnecessary cases of breast cancer likely occured. In 2001 Premarin was still the 3rd most popular drug sold in America..even as the reports slowly leaked from JAMA.

Drug companies are extremely powerful. There is no huge industry promoting smoking cessation, exercise, or eating healthy reasonable quantities of food even though these life style changes offer far more remarkable results than statins.

70% of all deaths are related to behaviour (obesity, unsafe sex, not wearing a seat belt, lack of exercise, smoking)..yet 95% of health care spending is directed at biomedically oriented medical care.

Abramsom believes drugs like Fosamax (to treat osteoporosis) are not indicated. 81 women have to take Fosamax for 4.2 years to at a cost of 300,000 to prevent one hip fracture. In turns out women who who exercised moderatly had 36% fewer hip fractures and Tai Chi cut the risk of falls in women over 70 by 70% (no small number considering 25% of the elderly who have a hip fracture are dead in 1 year).

Abramsom goes on discussing stroke, diabetes, heart disease and how life style changes offer more remarkable results than clot busting drugs, angioplasties, or diabetic medications or expensive medications like celebrex.

What are the solutions for health:

The simple solutions: avoid tobacco, exercise, eat healthy, have a BMI under 25, use seat belts and bike helmets, don't engage in unsafe sex.

The old mantra of prevention- prevention- prevention. But I certainly contend do people really change with proper counseling (often not with oral hygeine in my practice).

Abramson is right to want more transparency and more distance between medical journals and research and drug companies. Abramsom wants more doctors to become primary care physicians (family practice residents has dropped in the last 10 years form 17% to 8%). I think this approach is wrong--nurse practicioners and mid level providers can do adequate and more affordable care.

4 stars- informative book. My takeaway is keep exercising and you take less medicine and you will be healthier because of these changes!

[Laura · Rating 5 out of 5]

This was a great book, yes it was a little dry, but the information contained within really shined a light on something that I never really considered. It also gave me a lot to think about public health in US American and in other places of the world. I think even in the future this book will be held up as a call to everyone that morality matters in science when you are dealing with something that could effect a lot of people.

[Monty · Rating 4 out of 5]

Check out the summary of this book. Some of it can be skipped if you are already familiar with the issue (such as problems with hormone replacement therapy, the downside of statins, and so on). Actually you can pick and choose which chapters to read. What the book did for me was to drive home the data behind how the pharmaceutical companies disotort medical knowledge for their own gains, such as only reporting studies that seem to support their drug: selling the product is more important than the health of people. Pharmaceuticals have infiltrated the health delivery system so much that even the medical journals don't print accurate articles on how to treat illnesses. Plus the pharmaceuticals teach many continuing education classes for doctors and, or course, slant the information to meet their needs. It seems that the bottom line for a person to maintain one's health is to exercise, eat a healthful diet and not gain a lot of weight. For example, it is better for your health to exercise and have a good diet and have high cholesterol than to lower one's cholesterol with a statin drug. The last chapter includes proposals by the author: Provide universal health care (this would actually cost less in the long run than how our system is now), change the Medicare D plan so that Medicare can negotiate directly with drug companies, establish an independent oversight board similar to England's National Institute for Clinical Excellence (NICE) plus some other ideas.

[Yvonne Leutwyler · Rating 3 out of 5]

I know America's medical system is broken, but I didn't know it was THAT BAD. The information is a bit dated (2004), but I still see so much of it going on in health care, at least from my perspective (I am not an insider). I recommend this book for anybody, if it's too long-winded and dry for some people they should at least read the last chapter, which sums things up a bit. (Borrow the book from the local library - yes, they still exist). It would be nice to hear the other side of the story - from the drug companies, the academic community, and the government entities in charge of overseeing health care (FDA, NIH etc.). But even if they justified their actions (or, in case of government, INactions) I would probably still be enraged by their greed, indifference, and ignorance. I have noticed that my own health insurance (which I have had for less than 3 years) has encouraged a healthy lifestyle and is covering preventive care. I don't know if this is a recent development across the board, or if they are simply one of the better insurance companies. I like the fact that they are helping to empower the patient to be the best steward for his/her own health.

The author clearly researched the subject well and provides sources for his claims. However, despite all the good information provided the book is sometimes a bit redundant and dry, not an easy read (unless you're into statistics).

[Fabiola Miranda · Rating 3 out of 5]

I read this book about three years ago for a class. I was very surprised to find out about a lot of cases where the notorious drug companies (like Merck) produced a drugs that were approved by the FDA, even though they weren't supposed to. In the end, drugs like Celebrex and Vioxx, or drug replacement therapy drugs such as Premarin caused a lot of damage to people because they increased their risk of other types of cancer.

I don't know how to feel about this book. It is very one-sided and I would like to believe that I am fair enough to read the other side of the story, or at least find more information about these controversies. In any case, this book might cause a lot of eye-opening and shocked reactions. I was very struck by the contents of this book, but I realized that I also need to make my own decisions, and read everything that comes my way with a grain of salt.

[Michael · Rating 3 out of 5]

Didn't hate it and found it quite informative but it ended up repeating the same exact message way too often. How do we solve the problem - eat healthy and exercise and be informed. I would have preferred this more as a longer news article but don't let that deter you because I'm someone not in the medical field and felt bogged down by scientific info I couldn't fully grasp. For anyone in the medical field or an interest/understanding of medicine I would highly suggest it. I teach english at a pharmaceutical company and this book was good to read with students to spark conversation, debates and comparing and contrasting companies and country policies.

[Maggie · Rating 4 out of 5]

This book was written by a doctor who became aware of the increasing influence of pharmaceutical industry on the practice of medicine, decided to research the full extent of it and write a book. Very interesting (and scary). I really enjoyed the book and understand that it was fairly courageous of him to write it - he is challenging the status quo, and challenging his colleagues. Because of all that, I know that he needs to reference everything he says, but reading the continual references and so much evidence for everything did get a little old.

[Charlie · Rating 4 out of 5]

A Harvard M.D. exposes the systemic corruption of the pharmaceutical industry and how well meaning doctors are taken advantage of by it. He explores the bias with which drug studies are conducted, where medical journals get there funding, where continuing education seminars get there funding and more (And yes, drug companies is the answer to those last two questions). An interesting fact I learned is that few countries outside the U.S. permit the drug companies to market themselves direct to consumers, seemingly trivial but actually of monumental implications.

[Ariella · Rating 5 out of 5]

Loved it. Dr. Abramson uses his knowledge to go back and audit clinical trials that were used to push drugs through the FDA. While do so he discovered how many drugs should not have passed and were no better than placebo. It goes on. He made discovery after discovery and painted a picture in this book with the true ink of the pharmaceutical industry: money.

I interviewed Dr. Abramson about 6 years ago and he is a very thoughtful and thorough individual and doctor. The world needs more of him.