Best Quotes from Overdosed America by John Abramson with Page Numbers

The contrast between the care of my two patients, Mr. Black and Sister Marguerite, could not have been greater.

The recurring focal point of Sister Marguerite’s medical care—especially the troublesome skin ulcers—became getting her well enough to participate in special activities at the convent and enjoy her next trip to her grandniece’s home.

What I think is good doctoring—was becoming more difficult, and occasionally impossible.

I felt privileged, if a little ill at ease, to be included in this sad and beautiful scene.

Sister Marguerite’s acknowledgement of our common experience, though approached from different directions, felt like the most genuine of blessings.

When the history of this era of American medicine is fully written, there is no doubt that many of the scientific and technological advances will stand as great achievements.

I was glad that he trusted me enough to let me help.

Often the breakthroughs and sophisticated technology themselves weaken doctors’ ability to help their patients by drawing attention away from real encounters between real people.

I wondered how many lives like that of the woman to whom I had made the house call might be saved for the cost of preventing a single nonfatal stomach ulcer.

I realized the injustice of that equation.

A big part of becoming a doctor is learning to trust this scientific evidence enough to let it guide decisions that can have profound effects on vulnerable patients.

The collateral damage in establishing this belief is the diversion of doctors’ and patients’ attention away from far more effective ways to prevent stroke and achieve better health.

More than anything else in medical training, doctors are taught that good medical care is based upon a foundation of scientific evidence.

Simply eating fish once a week reduces the risk of stroke by 22 percent. Controlling high blood pressure reduces the risk of stroke by 35 to 45 percent.

The purpose of this article seemed incontrovertible: to establish 'scientific evidence' that would lead doctors to believe they were reducing their patients’ risk of stroke by prescribing Pravachol.

It felt like a violation of the trust that doctors (including me) place in the research published in respected medical journals.

Had the purpose of the study truly been to assist doctors in reducing their patients’ risk of stroke, it certainly would have mentioned other proven approaches to achieve that goal.

The research skills I had learned as a Robert Wood Johnson Fellow served me well in critically reading articles in medical journals.

Both articles focused almost exclusively on drug therapy rather than inexpensive lifestyle changes that have been shown to be far more effective.

I was losing my faith in the knowledge that guides medical practice, and there was no going back.

The serious gastrointestinal toxicity such as bleeding, ulceration or perforation of the stomach, small intestine, or large intestine, can occur... in patients treated with NSAIDs, including Celebrex.

The disparity between the CLASS article published in JAMA and the information in the FDA’s files by no means stopped there.

Something is very wrong with a system that leads patients to demand, and doctors to prescribe, a drug that provides no better relief and causes significantly more serious side effects.

The pressure from my patients to prescribe Celebrex and Vioxx did not let up, intruding into alliances that had been built up over many years.

The amazing thing is that the conclusions presented in these articles were based upon exactly the same data that the manufacturers had sent to the FDA.

I realized how little even the best doctors understood the risks of Vioxx when... a prominent cardiologist... had been unaware of the significant cardiovascular risk associated with Vioxx.

I had the opportunity to ask Dr. Janet Woodcock... why the FDA had not intervened in JAMA’s publication of the Celebrex study.

It seemed to be saying that Celebrex had just about the same risk of serious GI complications as other anti-inflammatory drugs.

This supposedly authoritative review article in the New England Journal of Medicine seemed to be stating as fact one of the 'unsubstantiated comparative claims' that the FDA had forbidden.

I tried to explain that these drugs offered no better relief than the older, less expensive anti-inflammatory drugs.

"...the process of engaging in a doctor-patient relationship is the most effective alternative medicine—using the safety and trust of the doctor-patient encounter as an opportunity to connect with deeper concerns..."

"Her capacity to heal the wounds in her life as best she could in preparation for her death brought a sense of hope to the tragedy of her situation."

"Despite the poor performance of the American health care system, our health care costs are simply staggering."

"One of the best single indicators of a country’s health... is called 'healthy life expectancy.'"

"The elimination of polio, the most feared disease of my childhood, is a perfect example of the triumph of American ingenuity."

"Our discoveries about the myth of excellence in American health care led me to realize that the commercialization of medicine wasn’t just causing doctors to prescribe unnecessary drugs and procedures. It was actually subverting the quality of medical care."

"...the introduction of inexpensive cotton undergarments easy to launder and of transparent glass that brought light into the most humble dwelling, contributed more to the control of infection than did all the drugs and medical practices."

"The only thing that appears to be certain about health care in our country is that we aren’t getting the health we’re paying for."

"...improvements such as sanitation, clean food and water, decent housing, good nutrition, higher standards of living, and widespread vaccinations... contributed more to the control of infectious diseases."

"We are losing the war against cancer."

"Yet Mrs. Clark was upset about two issues related to her medical care."

"She worked hard to get things right."

"Mrs. Clark told me that within a day or two after she first felt a lump in her left breast, she had seen her gynecologist."

"She expressed confidence that her treatment would be successful."

"Her illness had brought her even closer to her husband and children."

"The only time she cried was when she spoke about the prospect of losing her hair during chemotherapy."

"She did not make the same mistake again."

"She ended up profoundly disappointed with the medical system that had urged her to receive hormone replacement therapy."

"The truth about HRT came out very slowly and was difficult for most doctors to accept."

"Therapeutic decisions must be based on solid and unbiased scientific evidence."

"Establishing a relationship between each Medicaid patient and a primary care doctor responsible for providing and coordinating all medical care improved the quality of care and, at the same time, decreased costs."

"The truth is closer to Pogo’s discomforting epiphany: the enemy is us."

"The prospect of a win-win insurance arrangement providing better care for less money catalyzed the rapid change in U.S. health insurance."

"Coverage of the new plans held out the promise of actually improving people’s health."

"We have all been pulled into this enormous and complex system by our hopes and fears, our myths and ideologies, our dedication and pursuit of scientific knowledge, and our personal and institutional aspirations."

"Comparisons... show that access to comprehensive, family-oriented primary care service is the distinguishing characteristic of health care systems that are both effective at producing good health and efficient at controlling costs."

"It takes a tremendous amount of commitment and idealism to choose a career that is not supported by role models in training, carries less prestige among peers, intrudes more into one’s personal life, and pays far less than most other specialties."

"In retrospect one wonders why the NIH and FDA continued to support Rezulin long after it was known to be associated with so many deaths."

"Money from the drug industry has been pouring into politics, with the balance of support tipping progressively more toward the Republicans..."

"The transformation of medical knowledge from a public good... into a commodity, measured by its commercial value, is a key issue in our health care system."

"Caveat lector—let the reader beware."

"They are seduced by industry funding, and frightened that if they don’t go along with these gag orders, the money will go to less rigorous institutions."

"The precious objectivity of the clinical studies that were being published in their journals was being threatened by the transformation of clinical research into a commercial activity."

"Research done in university medical centers cost more and involved more administrative hoops and delays."

"Commercial influence on medical research raises two kinds of concerns: First, what is being studied? Those who pay the piper get to call the tune."

"If even the researchers who write the articles have access to only the data that the corporate sponsors allow them to see, how can anyone have confidence in the 'scientific evidence' published in the medical journals?"

"Almost certainly not. Research results cannot always be hidden when studies don’t come out in the drug company’s favor, but that doesn’t mean drug companies don’t try to influence researchers to minimize the damage."

"There is nothing illegal or unethical about these commercial arrangements, but both the public’s interest and the commercial sponsor’s interest cannot always be served simultaneously."

"Medical research, even if it is conducted by the pharmaceutical industry, is not solely a commercial enterprise designed to maximize personal gain or company profits."

"The responsible conduct of medical research involves a social duty and a moral responsibility that transcends quarterly business plans or the changing of chief executive officers."

The sheer volume of new material is overwhelming.

Doctors are invited to learn about new medical breakthroughs at free suppers and conferences in tropical paradises.

Doctors tend to believe that they are immune to drug company influence.

According to Dr. Richard Smith, 'The major journals try to counterbalance the might of the pharmaceutical industry, but it is an unequal battle—not least because journals themselves profit from publishing studies funded by the industry.'

Had doctors been aware of these findings earlier, their use might have been stopped sooner.

The mistakes of medicine are always easier to see through the 'retrospectoscope.'

Any attempt to recommend a specific drug is likely to be based on biased evidence.

Twisted together like the snake and the staff, doctors and drug companies have become entangled in a web of interactions as controversial as they are ubiquitous.

According to a news release from Massachusetts General, the money will be used to support educational activities, including continuing medical education courses.

The only thing that matters is how to influence doctors.

The new guidelines call for doctors to measure adult patients’ cholesterol and triglyceride levels every five years.

The excitement generated by these new guidelines was unprecedented.

If the new guidelines were followed, coronary heart disease 'would no longer be the number one killer [in the United States].'

These statins are amazing drugs.

The guidelines make specific recommendations for men, women, and people 65 and older who do not have coronary heart disease.

Cholesterol is vital to many of the body’s essential functions.

The real goal of medical care is... not simply to lower blood levels of LDL cholesterol.

Physical activity, unlike total cholesterol levels, is highly correlated with overall mortality rate.

Statin therapy does not reduce the risk of developing heart disease or stroke.

Competent and caring physicians trying to provide the best possible care for their patients are being misled.

The American public can no longer blindly trust that its vaunted medical journals and world-class medical experts put the interests of patients first.

Becoming well informed and reclaiming personal responsibility are the best antidote to a fundamentally flawed system.

Patients do indeed need to become medical consumers, but not just of drugs, doctors, and hospitals.

We need to become critical consumers of medical knowledge itself.

Advertising serves not so much to advertise products as to promote consumption as a way of life.

A good example was provided by the press coverage that followed the publication of a 2002 article in the New England Journal of Medicine.

What’s the harm in all this excitement about something that may not be a real breakthrough? The hype creates false hope that moves us further away from real prevention.

The public needs access to independent expert opinion that can counterbalance the enormous influence that the medical industry wields over our beliefs about the best approach to health and medical care.

We are left with medical reporting that is handicapped by a structural disadvantage: the public’s interest gets overwhelmed by the financial resources, political influence, and marketing expertise of the drug industry.

While there certainly have been many real breakthroughs in research and practice, it turns out that most of the medical news, especially the commercially advantageous news, is too good to be true.

“When we disagree, I just let my wife think she’s right.”

“More care is not necessarily better care.”

“It’s business, pure and simple.”

“Markets respond more rapidly than bureaucracies to the changing technology and new innovations.”

“Preventive medicine does not bring in the big bucks.”

“You would think that there would be a mechanism in place to ensure that our medical care was based upon a solid foundation of medical research.”

“When seniors are actually given the opportunity to express their end-of-life preferences, 71 percent say they would rather die at home than in a hospital.”

“Despite the clear preferences for less invasive and less hospital-based care, people’s end-of-life wishes are usually ignored.”

“The primary variable determining where and how people die is not their expressed preferences but the availability of hospital beds in their area.”

“The conclusion is that excess health care expenditures in the United States in 2004 will amount to about $530 billion.”

It is much more important to know what sort of patient has a disease than what sort of disease a patient has.

No knee is an island. Even if the biological process of cartilage destruction were completely understood, the biomedical explanation of osteoarthritis would still provide a grossly inadequate understanding of the inflammation in Mrs. Martin’s knee.

The cells in Mrs. Martin’s knee were malfunctioning because her walking was causing more wear and tear than Mother Nature had designed her knee to withstand.

The temptation to order an x-ray or MRI and prescribe the latest arthritis medicine for a patient like Mrs. Martin is great.

There is no place in the biomedical model for patients to have personhood.

Significant and lasting change in behavior often requires changing the deep assumptions that sustain this paradigm of self.

Doctors provide appropriate counseling to their patients only 18 percent of the time.

In the arena of modern biomedicine, attempts to integrate the interpersonal aspect of healing into patient care are looked upon, at best, as an extracurricular activity.

The unspoken principles of biomedicine are communicated and enforced by the well-defined and ever-present structure of authority.

A less constraining paradigm would value different metaphysical perspectives equally.

"The benefits of medical care are real but limited, and more is by no means always better, and is often worse."

"The challenge in determining optimal medical care is to identify the boundary between the effective care that truly improves health and the commercially driven care that at best misdirects our efforts to stay healthy."

"The evidence from study after study shows that we can usually do a great deal more to maintain our own health than the medical industry promises it can do for us."

"Routine exercise and a diet with adequate calcium makes future problems far less likely."

"The reality is that two out of three hip fractures occur in women who have reached the age of 80."

"Proper exercise and good nutrition are important through all stages of life to build and maintain strong bones."

"Engaging in activities that increase strength and balance helps decrease the risk of falls."

"The evidence shows that it’s not too late to change your sedentary ways."

"The bottom line is that type 2 diabetes is primarily a disease of lifestyle."

"Preventive health care must integrate the health consequences of how we live our lives."

"In a science-driven organization, the notion of marketing versus science is really a false dichotomy."

"The ideal of 'well-ordered science'... is often replaced in commercially sponsored medical research by the ideal of profit-maximizing science."

"Nothing less than a new independent national public body is needed to protect the public’s interest in medical science."

"The most important health care issue in the United States today is whether our current method of creating medical knowledge realizes the full potential of medical science to improve our health."

"If democracy is to be more than a ritual dance choreographed by powerful corporations in this postindustrial 'information age,' government must actively protect the integrity of the information on which we rely to guide our personal and political choices."

"The foundation of good medical care is an ongoing relationship with a primary care physician with whom you feel comfortable."

"Commercial interests are so successful in appearing to represent the public’s interest that doctors, health policy experts, and the public are unable to discern the commercial distortions of the medical knowledge upon which they rely."

"Genuine change requires the exercise of real autonomy. This means a willingness to accept responsibility for maintaining your own health."

"The key to understanding this paradox is that the medical industries maximize profits by providing the most care possible to those who pay full or almost full price."

"We have come to a critical juncture, and our future depends on our willingness to act on our country’s highest ideals."