Prologue:  Different strokes

Case studies of patients who had neurological catastrophes because of the drugs they took, or the drugs they failed to take.



Chapter 1: The pregnant mare's lesson

The prescription medicine most frequently used by American women didn’t work the way it was supposed to, and often caused more harm than good. How could this happen?

Chapter 2: Leaving the Dark Ages behind, mostly

It took western science thousands of years to figure out how to tell a good treatment from a worthless one, and only a decade to forget.



Chapter 3: The fat is in the fire

A drug in the popular “fen-phen” diet pill combination was known to cause serious lung disease, but it was prescribed to millions anyway – until it was taken off the market.

Chapter 4: Too sweet to be true

A new diabetes drug looked like a breakthrough treatment until it was withdrawn in Europe because of unexpected fatalities. Why did it take two more years for U.S. authorities to reach the same decision?

Chapter 5: Cold comfort

Few would expect that an over-the-counter treatment for the sniffles, found in most American medicine cabinets, could lead to cerebral hemorrhage. But the evidence had been there for decades.

Chapter 6: Getting risks right

All drugs have downsides, but many of them aren’t discovered until a product is in widespread use. We could do much better at spotting these problems early.

 Chapter 7: The most vulnerable patients

The elderly fill the most prescriptions, benefit the most from them, pay the biggest pharmacy bills, and have the greatest risk of side effects – many of them preventable. Yet they’re the least likely to be included in drug studies.

Chapter 8: Enter Doctor Faustus

Every prescription is a tradeoff between benefit and hazard. How can the good that a medicine does be fairly stacked up against its hazards?

Chapter 9: Imperfect measures

Scientists have developed ways to compare the relative “worth” of drugs to treat cancer vs. depression vs. erectile dysfunction. But how well do such measurements really stand up?

Chapter 10: Whose risk is it, anyway?

Legal, moral, and medical quandaries arise when doctors, patients, and society have different views on whether it’s worth taking a chance on a potentially dangerous treatment.

Chapter 11: A balancing act

Physicians and policymakers are routinely forced to make tough choices about whether a given medication is “safe enough” to use. Usually we get it right.



Chapter 12: Live cheap or die

One New England state’s disastrous experiment in trying to save money by rationing prescription drugs.

Chapter 13: Filling the pipeline

Where do new drug discoveries really come from?

Chapter 14: What the traffic will bear

Americans pay more for their drugs than the citizens of any other country. How did we get into this fix?

Chapter 15: Navigating the third dimension

Philosophers have debated the value of a human life for centuries. When it comes to paying for medications, those debates become a central part of health policy



Chapter 16: Signals, noise, and the big void

How do we make sure that doctors and patients have all the information we need to make the right drug choices?  We don’t.

Chapter 17: Informational kudzu

Madison Avenue succeeds in filling the informational vacuum for prescribers and consumers alike with a limitless flow of attractive factoids.

Chapter 18: Devising an antidote

Using the pharmaceutical industry’s own tactics to convince doctors and patients to use medications more sensibly.

Chapter 19: The emperor's fashion critics

Medicine has a long and depressing history of scientific whistle-blowers and their usually unhappy fates.

Chapter 20: Same language, different accents

Somehow Australia, England, and Canada have developed better systems than the U.S. for educating physicians and consumers about prescription drugs.



Chapter 21: Pulling the facts together

FDA requires only that a new drug must work better than placebo; we have to do a better job of comparing them with one another.

Chapter 22: Turning knowledge into action

An innovative proposal for getting the straight dope about drugs out into doctors’ offices and patients’ homes.

Chapter 23: Markets and medicines

Moving beyond simplistic ideas of commerce and profit as the guiding principles of drug use and medical care.


Epilogue: The triple-edged sword

We need a new way of thinking about benefits, risks, and costs to make the most out of the therapeutic revolution that lies before us.