Rethinking Medications

PUBLISHERS WEEKLY FEB 10, 2025

In this troubling report, Avorn (Powerful Medicines), a professor of medicine at Harvard Medical School, explores problems with the development and administration of medicine. Charting America's history of underregulating drugs, Avorn notes that listing a medication's contents on its container only became mandatory in 1906, and that a 1962 law marked the first time pharmaceutical manufacturers had to prove to the Food and Drug Administration that a medication works before bringing it to market. Such safety measures are imperiled today, Avorn contends, warning that since the 1980s, successful efforts by pharmaceutical industry lobbyists to loosen testing standards for FDA approval have left doctors with a more limited understanding of new drugs' side effects. Avorn blames the pharmaceutical industry's lack of transparency for endangering patients, recounting how the drug manufacturer Merck received approval for the painkiller Vioxx, which was later found to increase patients' risk of heart attack, based on distorted research that withheld evidence of the side effect. Sensible suggestions for ameliorating such harms include requiring pharmaceutical companies to upload all trial results to a public database and stipulating that clinical trials must compare a new drug's efficacy and safety with the best available current treatment, instead of just a placebo. A damning survey of the drug development system's many failures, this enlightens even as it infuriates.