The medical profession which John Abramson writes about in Overdosed America does not resemble a Norman Rockwell painting in any way. The current state of affairs is rather more dangerous and damaging – for both Americans’ health and their pocketbooks – than even your family doctor may realize. Overdosed America charts how this state of affairs came about, what the costs have been in both dollars and lives, and what Abramson, a practicing physician and teacher at Harvard, sees as the best case scenario to fix current problems and reform the system to meet current and future needs.
Where the book really shines is in Abramson’s detailed chapters exploring how the medical industry has, since World War Two, valued profits over lives when developing treatments for everything from menopause to heart disease. These chapters constitute the bulk of the book and have a tendency to feel long and dry, a problem for a book written for a lay audience. I fought the urge to skip ahead to the last three chapters, Abramson’s recommendations, mainly out of a perverse desire to see how often the drug companies have defrauded and deceived the public. The facts disclosed here are truly stunning, and worth reading for shock value alone. But they also go a long way toward creating a fuller picture of the crisis in American health care.
Time and again Abramson painstakingly details the triumph of commercial interests over scientific evidence. As familiar as this refrain is to anyone familiar with the Bush administration, Abramson traces the beginnings of this state of affairs to the Food and Drug Administration’s 1942 approval of Premarin (estrogen) “for the treatment of symptoms associated with menopause.” (159) Wyeth-Ayerst still holds the patent for processing “PREgnant MARe’s urine” into a drug effective at relief of symptoms felt by a minority of women, which “last no more than two to five years.” (ibid.) Marketed as part of a hormone replacement therapy (HRT) to protect all women against the ravages of old age, over 20 million American women bought into this therapy. Effects of HRT included: a “66% higher chance of getting breast cancer,” a 50% increase in the risk of developing Alzheimer’s disease, and a 15% chance of suffering at least one “adverse event” – heart attack, stroke, blood clots, dementia, breast cancer, and so on – after five years of therapy. (ibid.)
Abramson discusses many other cases, all with the same bottom line: American pocketbooks are more important to the medical industry than American lives. If this doesn’t sound like an urgent problem in need of an immediate solution, next time you’re over at your grandparent’s house, open up their Reader’s Digest. About 40% of the advertisements are for new and popular drugs.
Abramson discusses in Part Three of the book alternatives to biomedical (drug and surgery) therapies, supporting options such as lifestyle counseling and increased exercise regimens with study after scientific study proving their effectiveness. This is not to the detriment of biomedical therapies, which he is careful to note are valuable in situations “from emergency surgery… to the treatment of strep throat.” (204) However, when the U. S. Centers for Disease Control and Prevention report that “‘half of all deaths that occurred in the United States in 2000 could be attributed to… largely preventable behaviors and exposures,’” it may be time to look beyond the latest and greatest and most expensive pill, and return to a little common sense and conventional wisdom.
Of course, the difficulty, which both doctors and patients face here, Abramson states, is that non-biomedical therapies are often strongly reliant upon behavioral changes. These behaviors – lifestyle choices – are more difficult to prescribe and adhere to. Just ask anyone who has tried to quit smoking.
Further, the extent to which the big drug companies are able to influence medical opinion reminds one of the great investigative journalism of the American press. Abramson writes “experts with financial ties to the drug companies dominate the FDA’s Advisory Committees and the panels that write the clinical guidelines that define the standards of care for practicing doctors.” (250) As if it isn’t enough to control the testing and approval of new biomedical therapies, “the medical industry even funds the majority of doctors’ [required] continuing education.” (ibid.) This points toward a conflict of interest throughout the medical industry, but, as Abramson is right to point out, “the drug companies have no more responsibility to oversee the public’s health than the fast-food industry has to oversee the public’s diet.” (ibid.)
With that information, plus all of the other facts, figures, and recommendations that Abramson reports in Overdosed America, it will be obvious to any reader that America’s health care industry has become corrupt. Significant, long-term changes need to be made everywhere from medical school classrooms to drug company boardrooms. John Abramson’s report is an eye-opening look beyond that Norman Rockwell façade. The lesson he wants us to learn is that an apple a day is still the right dose.