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A new diabetes drug looked like a breakthrough treatment until it was withdrawn in Europe because of unexpected fatalities.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.