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meret, reflecting my new love for Laura Roslin on BSG. Smallville still has my visceral passion, but BSG is gaining a hold on my mind.
This is an engagingly written investigation of the tough choices and systemic problems surrounding one of the most critical parts of medical care in the US, the use of and failure to use prescription drugs. The prologue, though groaningly titled “Different Strokes,” is actually a very powerful argument through example: the author goes through a number of case histories of people who had - or in one case, didn’t have - strokes, some because of the medications they took, some because of the medications they didn’t take. Wealth matters to these stories, as does education, as does race, as does nationality – it’s not an accident that the guy who doesn’t die of a stroke is Canadian. (He does of course die in the end, like the rest of us will.) Avorn has thought hard about this stuff, and he’s fair and balanced in his treatment, as the title of the book suggests. Among other things, he clearly explains why randomized controlled trials are best to determine if a drug is effective, but population-based observational studies are necessary to determine the real risk profile of the same drug. He also traces the multiple factors contributing to rising drug costs, including doctors who have no idea how much the drugs they prescribe cost (or even if the drugs work) and drug companies whose natural imperative to make money has led them to drown out and sometimes even suppress evidence-based evaluations of drug efficacy.
The book is a comprehensive look at most aspects of drug policy, though it’s perhaps most limited on the question of drug research, which isn’t his speciality. It’s notable that again and again the book reminds Americans that our system is wacky compared to that of other industrialized nations, who have universal health care and pay a lot less overall for basically the same outcomes. (I suspect – though I haven’t seen anything about this directly – that the “same outcomes” is comprised of a bunch of Americans with good health insurance and time on their hands to insist on good care, who have better-than-average outcomes, and a bunch of Americans who lack the money, information and time and have worse-than-average outcomes. So if you’re going to get really sick, it’s best to be a rich American, but failing that you should try to be Canadian.)
Avorn is a witty writer, though sometimes too clever by half; I liked a lot of his folksy analogies, and especially his label for proponents of many supplements/“alternative” therapies, whose evidence is that some people believe that supplements worked for them – “the Tinkerbell school of pharmacology.” Stupid policies that have already failed are, when proposed again, not “reinventing the wheel” but “reinventing the flat tire.” I particularly enjoyed his description of “a breakthrough that had some similarities to the discovery of the internal combusion engine: it unleashed much useful power and a great deal of smog.”
On the other hand, he fails when he tries to extend metaphors until they snap -- things like “The industry claims that the issue is pregnant with ominous portent for the future of medicine. But for many scientists, its logic just leaves stretch marks on one’s credulity, and fails to deliver ...” His discussion of Viagra is more suited for a puling schoolboy, using words like limp, rigid, slippery, “digits inserted into the model,” etc. in rapid succession, ad nauseum. I hate to say it, but the book could have benefited from an editor who’d make the tone more serious, consistent with its life-and-death topic.
Avorn’s prescriptions are less powerful than his diagnoses. Because he believes that Americans will not stand for state-funded medicine in the manner of most modern industrial nations, he proposes a series of interconnected jury-rigged measures that might possibly mimic the information-collecting and decision-controlling benefits of a unified health care system. I can’t say I’m confident any of that would work, but the fault is probably not with the proposals but with American exceptionalism.
The book has a website that also might be of interest.
meret, reflecting my new love for Laura Roslin on BSG. Smallville still has my visceral passion, but BSG is gaining a hold on my mind.This is an engagingly written investigation of the tough choices and systemic problems surrounding one of the most critical parts of medical care in the US, the use of and failure to use prescription drugs. The prologue, though groaningly titled “Different Strokes,” is actually a very powerful argument through example: the author goes through a number of case histories of people who had - or in one case, didn’t have - strokes, some because of the medications they took, some because of the medications they didn’t take. Wealth matters to these stories, as does education, as does race, as does nationality – it’s not an accident that the guy who doesn’t die of a stroke is Canadian. (He does of course die in the end, like the rest of us will.) Avorn has thought hard about this stuff, and he’s fair and balanced in his treatment, as the title of the book suggests. Among other things, he clearly explains why randomized controlled trials are best to determine if a drug is effective, but population-based observational studies are necessary to determine the real risk profile of the same drug. He also traces the multiple factors contributing to rising drug costs, including doctors who have no idea how much the drugs they prescribe cost (or even if the drugs work) and drug companies whose natural imperative to make money has led them to drown out and sometimes even suppress evidence-based evaluations of drug efficacy.
The book is a comprehensive look at most aspects of drug policy, though it’s perhaps most limited on the question of drug research, which isn’t his speciality. It’s notable that again and again the book reminds Americans that our system is wacky compared to that of other industrialized nations, who have universal health care and pay a lot less overall for basically the same outcomes. (I suspect – though I haven’t seen anything about this directly – that the “same outcomes” is comprised of a bunch of Americans with good health insurance and time on their hands to insist on good care, who have better-than-average outcomes, and a bunch of Americans who lack the money, information and time and have worse-than-average outcomes. So if you’re going to get really sick, it’s best to be a rich American, but failing that you should try to be Canadian.)
Avorn is a witty writer, though sometimes too clever by half; I liked a lot of his folksy analogies, and especially his label for proponents of many supplements/“alternative” therapies, whose evidence is that some people believe that supplements worked for them – “the Tinkerbell school of pharmacology.” Stupid policies that have already failed are, when proposed again, not “reinventing the wheel” but “reinventing the flat tire.” I particularly enjoyed his description of “a breakthrough that had some similarities to the discovery of the internal combusion engine: it unleashed much useful power and a great deal of smog.”
On the other hand, he fails when he tries to extend metaphors until they snap -- things like “The industry claims that the issue is pregnant with ominous portent for the future of medicine. But for many scientists, its logic just leaves stretch marks on one’s credulity, and fails to deliver ...” His discussion of Viagra is more suited for a puling schoolboy, using words like limp, rigid, slippery, “digits inserted into the model,” etc. in rapid succession, ad nauseum. I hate to say it, but the book could have benefited from an editor who’d make the tone more serious, consistent with its life-and-death topic.
Avorn’s prescriptions are less powerful than his diagnoses. Because he believes that Americans will not stand for state-funded medicine in the manner of most modern industrial nations, he proposes a series of interconnected jury-rigged measures that might possibly mimic the information-collecting and decision-controlling benefits of a unified health care system. I can’t say I’m confident any of that would work, but the fault is probably not with the proposals but with American exceptionalism.
The book has a website that also might be of interest.
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And what of BSC '80??? Think of the (space) children!
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Good times!
I think maybe "BSG" is going to stand for today's BSG, just because it seems to be the new up&coming fandom -- there must have been Apollo/Starbuck zines back in the day, but BSG 2004 gets first dibs on the unadorned abbreviation for Internet fandom. At least that's what I've seen so far.
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I'm hoping you'll be inspired to write Laura/Lee fic. I'd love to read your take on it. :)
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You were so young, did you "get" that Troy (played by Kent McCord) was Boxy, grown up?
The only episode of BSG '80 that made it to VHS was the flash-back episode with Starbuck. We bought it at Disneyland about 15 years ago, no idea what happened to it.
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I have fond memories of the original, but it was bad, utterly cheesy.
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Why wouldn't they, though? *curious*
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Because you write good fic and I want you on my team. ;) Seriously, though. C'mon in, the water's just getting warm.