In this episode, Phil Tower welcomes Dr. Jerry Avorn, MD, a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system.Dr. Avorn joined us to discuss his excellent new book, RETHINKING MEDICATIONS.
Groundbreaking research has given us many decades of remarkable new medicines, but America’s drug evaluation process, once the envy of the world, is being seriously compromised. Under pressure from drugmakers, the FDA has been lowering its approval standards and has let poorly effective or risky products enter the market, while our prescription prices, the highest in the world, put crucial treatments beyond the reach of many.
Get the Book: RETHINKING MEDICATIONS, - Simon & Schuster (Blackstone Publishing, Inc.)
Groundbreaking research has given us many decades of remarkable new medicines, but America’s drug evaluation process, once the envy of the world, is being seriously compromised. Under pressure from drugmakers, the FDA has been lowering its approval standards and has let poorly effective or risky products enter the market, while our prescription prices, the highest in the world, put crucial treatments beyond the reach of many.
Get the Book: RETHINKING MEDICATIONS, - Simon & Schuster (Blackstone Publishing, Inc.)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
It's West Michigan Weekend from my Heart Radio. Thank you
so much for tuning in. I am so glad you
have joined us. And let's talk about medicine, specifically medications,
and if you think about that, that ties into healthcare
and maybe the health plan. And for decades, let's not
take this for granted. We've had some amazing and remarkable
(00:21):
new prescription medicines available, even if you go back about
one hundred years to penicillin and antibiotics and everything in between.
But over the decade, over the last several decades, and
this has been decades in the mazing making, the prescription
drug business has become a big complicated mess, lots of
(00:42):
money and money driving things. And that's why I'm so
pleased to welcome in this segment a real expert, the
pre eminent expert in this area, doctor Jerry Avorn, MD,
Professor of Medicine at Harvard Medical School, a senior internest
with the mess General Brigham Healthcare sit.
Speaker 2 (01:00):
That's a mouthful. He is a leading.
Speaker 1 (01:03):
Expert and researcher at Harvard to study medication use, outcomes,
cost and policies. And he's been keeping his eyes on
this issue of medical cost, what gets approved, out of
control cost, etc.
Speaker 2 (01:19):
You name it. There's a brand new book that you're
going to want to pick.
Speaker 1 (01:22):
Up, especially if you are on prescription medicines or you
want to stay on top of this. The book is
called Rethinking Medications. Just out in late April from Simon
and Schuster. Boy, doctor Jerry Avorn. That was a ridiculously
long introduction. I'm so glad you're here. Thank you so
much for joining us.
Speaker 3 (01:41):
I'm very happy to be with you, Phil, Thanks for
having me.
Speaker 1 (01:43):
Well, you've written another book, and you've written hundreds of
journal articles.
Speaker 2 (01:48):
Why did you know?
Speaker 1 (01:50):
When did you know it's time to write Rethinking Medications?
The problems that big I'm assuming?
Speaker 3 (01:56):
Well, yeah, and also it's an interesting it's not only
problems as well, so good news and nice developments, and
it seemed like a good time to kind of pull
it all together. And when I began writing it, little
did I know how incredibly complicated things would be in
our early to mid twenty twenty five, where a lot
of things we assume about medicines and healthcare kind of
(02:18):
up for grabs.
Speaker 2 (02:18):
Now they certainly are.
Speaker 1 (02:20):
And let's state perhaps the most obvious thing for the
start of this conversation as we look at rethinking medications
and the importance of just understanding the medications available to you.
Your doctor is going to prescribe things or recommend things
for you. There are a lot of reasons behind that recommendation,
(02:41):
but the bottom line I would assume doctor Jerry Avorn
is a lot of us are quite naive about the
medicines were prescribed. We might see something on TV, get
a referral from a friend. Do you think we're lazy,
ill informed, or both.
Speaker 3 (02:57):
None of the above. I think that most doctors and
most patients are really working hard to do the right thing,
and it's hard to be a patient. It's also hard
to be a doctor in terms of getting on top
of the vast amount of information that's out there. And
part of the books intent was to try and make
that somewhat more doable, because it's life and death, and
(03:21):
if we get it right, we've got fantastic medications that
can really help extend people's lives, make the quality of
life better. But if we don't get it right, whether
the we is the doctor or the patient, we can
get into a lot of trouble. So that's kind of
the goal behind the book.
Speaker 1 (03:36):
Yeah, is the broken healthcare system a part of this
issue or is it bigger than that?
Speaker 3 (03:42):
Jerry, Well, I'm afraid that we do have a healthcare
system that is working nowhere near as well as it
could in terms of people getting access to care, being
able to afford care, particularly their medications, being able to
feel like you can get help when you need it.
We are not doing as good a job in the
country as we ought to, and the hope is to
(04:04):
kind of point the way, because you know, we could
do it better. We're spending more on healthcare per person
and twice as much on medications per person than any
other wealthy country in the world, and yet our outcomes
are either average or a little below average. So we
ought to be able to do better. We got the resources,
we just need to figure out how to do it
(04:25):
a little bit smarter.
Speaker 1 (04:26):
Well, if we have the resources, then why aren't we
doing it smarter now? Is it because of the power
of big pharma or the reasons?
Speaker 3 (04:33):
Well, yeah, I think your right, Phel that the politics
is an important piece of it. That a lot of
our drug policies are driven very, very heavily by the
drug industry, and they do some very useful things, but
they're also a political powerhouse, and it's the largest lobbying
effort in the country is from the pharmaceutical industry, and
(04:54):
they tend to have their way with congress people and
people in the executive branch. On both sides of the aisle.
We've seen some really bad policies made by Democrats and
by Republicans. And yeah, when there's that many dollars at stake,
over half a trillion dollars a year, it buys a
lot of influence and a lot of pressure.
Speaker 1 (05:13):
We're speaking with doctor Jerry Avorn. His new book is
Rethinking Medications, taking a look at the whole process of
prescription medicines, especially the drug evaluation process, which you say
in the book is being seriously compromised not only by
the pharmaceutical companies, but especially right now in the times
(05:35):
we're living in the current presidential administration, maybe even by the.
Speaker 2 (05:40):
FDA and beyond that.
Speaker 1 (05:42):
Help us unpack that issue as far as the evaluation
of drugs, doctor Jerry, everyone and kind of looking in
the future a little bit, do you see this getting
worse before it gets better?
Speaker 3 (05:56):
Yeah, I'm worried about the future because what the FDA
used to be the glory of the world in terms
of its very scientific and unbiased evaluation of medicines, and
then during the AIDS crisis, there was a reform that
was really full of good intentions of let's leed drugs
out there before they're completely evaluated, because people are dying
(06:18):
and we don't have any good treatments, and so something
called accelerated approval was created as a means to get
drugs to people who were going to die otherwise. And
that was a good idea back in nineteen ninety two
when it was started. But what we've seen now is
that there's been a lot of pressure from the industry
to get drugs approved on this accelerated pathway. Even if
(06:40):
they could have done better studies, or if they could
have shown whether it really helps people, they're able to
kind of sleeze by and have drugs approve based on
only a small improvement or change in a lab test,
and then the FDA has said, okay, fine, we'll give
it accelerated approval, and then has not done the second
half which was anticipated as part of the plan, which
(07:02):
is tell the companies to now go ahead and do
the big studies to really show if it helps patients.
A lot of the companies just drag their feet sell
the drug at whatever price they choose, often a high price,
and the FDA has been really pretty bad at getting
them to follow up and actually do the studies that
we need to know. Is this just changing a lab
(07:23):
test or is it helping the patient?
Speaker 2 (07:26):
Doctor Avorn.
Speaker 1 (07:27):
It's hard to watch anything on TV without seeing pharmaceutical
drugs being advertised. It's hard to watch anything on TV
without seeing pharmaceutic drug drugs being advertised and a very
long and complicated list of potential side effects and dangers
of taking the drugs. I think you just spoke to
that to an extent, but the advertising of these prescription
(07:52):
drugs alone may be causing part of the problem as well.
Speaker 2 (07:56):
I just like to get your take on that.
Speaker 3 (07:58):
Absolutely. And you know, no other country on Earth allows
that except New Zealand, but that's a different story. But
every other country says what we set up until nineteen
ninety seven. No, these are too complicated a question to
have this be the subject of a sixty second TV
commercial with actors and colors and music and stuff. You know,
(08:19):
that's kind of degrading the whole thing, and most every
place else on earth that's not legal, but here it is.
And I think it's kind of a waste of money,
a waste of time. And the last thing that a
doctor needs is to have a patient come in saying
I saw this commercial on TV last night, Give me
that drug please. It's we could think of a lot
of better ways of spending that those tens of billions
(08:42):
of dollars that are spent on those commercials.
Speaker 1 (08:45):
I want to ask you about the and celebrities in
those commercials selling those drugs too, a lot more celebrities.
It must be money that's too hard to turn down.
I'm glad you said that. I want to ask you
about the relationship doctor Jerry Avorn. Your new book is
Thinking Medications, the relationship between a patient.
Speaker 2 (09:04):
And their primary care physician.
Speaker 1 (09:05):
Maybe they're specialists and drug recommendations. How confident can we
be that we're gaining unbiased information.
Speaker 3 (09:13):
Well, as I said, doctors really try to do the
right thing. And I don't think the problem is that
we've got doctors who are either being dishonest or venal
or dumb. It's just very, very hard to keep up
with all the information that's out there and I think
in general, and there's some suggestions in the back of
the book about ways to talk to your doctor to
try to kind of figure out is this the right
(09:36):
drug for me? And is there an affordable alternative? And
what side effect should I look out for so the
patient can really advocate for themselves and have a good
conversation with the doctor. Now, of course, the problem is
that primary care doctors are under such assault to see
people too fast, and to see too many per morning
or afternoon, and it doesn't allow enough time for that.
(09:59):
But you know, most some of them are very good,
smart folks who are trying to do the right thing.
You just kind of have to grab them, buy the
lapel for a second and say, look, if you want
me to put this into my body, I need at
least two minutes for you to explain to me what
it's for and can I afford it and what should
I look out for.
Speaker 1 (10:15):
We're speaking with doctor Jerry Avorn. He is Professor of
Medicine at Harvard Medical School, senior internest in the Mass
General Brigham Healthcare System, pre eminent expert on prescription drugs
and medications, and the new book is Rethinking Medications from
Simon and Schuster out and available wherever books are sold.
(10:36):
Conventional wisdom says, as we get older, we take more medications,
more prescriptions. But who did you write Rethinking Medications for?
I mean, people at all ages take drugs?
Speaker 2 (10:46):
Who should? Who should? Who should? Get this book?
Speaker 3 (10:49):
Well, it's really written for all ages because certainly older people,
and I'm one of them, take a lot of medications,
and that's a good thing because they're keeping us alive,
they're helping us to function. So I don't see medications
as being, you know, a negative. They're really a positive
in that sense. But there's also a section in there
about psychedelic drugs, which will probably appeal more to younger people.
(11:10):
There's a lot there about opioids, and that's all ages
get pain, and all ages need to worry about making
sure that they get their pain relieved without getting addicted.
So it's really, you know, from cradle to grave, I think,
is the audience of just normal humans.
Speaker 1 (11:26):
I love that we could do a whole other segment,
Jerry on the psychedelic drugs. Maybe I'll have you back
on that one. Would be pleased to do it.
Speaker 3 (11:33):
It's become a really interesting question, and it's very much
on everyone's minds these days.
Speaker 1 (11:38):
Well, I love it, I absolutely love it. I don't
have a lot of time left. I want to ask
some questions I've been dying to ask. Connected to you
and rethinking medications. Is there a most dangerous class of
drugs today?
Speaker 3 (11:50):
Well, the opioids have been understood to be very dangerous.
I think we're beginning to get on top of that
because I think finally doctors are understanding that, contrary to
what we were told by the opioid manufacturers, these are
not God's gift and everybody should get them whenever they want.
But they really, we now know, can have bad risks.
(12:11):
So that is certainly my candidate for a dangerous drug category.
But we're learning, We've learned, I think that to not
listen to what the manufacturers told us and to really
treat them with a lot of respect and caution.
Speaker 1 (12:23):
Widely popular class of drugs, the new weight loss drugs
will go vio zempic or lestat. There's a whole bunch
of them in their doctor Jerry Avorn, what do we
know about their long term safety?
Speaker 3 (12:35):
Well, they are astonishingly safe as far as we can
tell now. Which is a pleasant surprise. You think that
something used so widely might be causing some scary symptoms
that we don't know about. But they've been used for
enough years in enough millions of people that at least
the ones we've got now are astonishingly safe. But probably
(12:55):
is that just so damn expensive. That's their main sort
of side effect. We call that financial toxicity. But if
it weren't for the cost, I think even more people
would be able to be benefiting from them, because you know,
they do control weight, they're a good fear, you know,
preventing heart disease, kidney disease, sleep apnea. There are a
remarkable class of drugs. I just wish they didn't have
(13:17):
a list price of one thousand dollars a month.
Speaker 1 (13:20):
Doctor Jerry Avor and our guest. His book is Rethinking Medications,
available wherever books are sold, just out in late April
on Simon and Schuster. And I have so many questions.
We've got a couple of minutes left. I want to
ask you a personal question. You've been a doctor for
a long time. What lit a fire in you passion
(13:42):
for understanding medications and this area of study.
Speaker 3 (13:46):
Well, when I was a medical student that starts in
nineteen sixty nine. I was struck with the real difference
between all the really elegant science we are learning in
our classrooms over at Harvard Medical School. And then I'd
get out and see what was happening kind of in
typical practice, and it didn't always match up. You know,
there was a lot of medication used that didn't seem
to fit the science we are being taught, and I
(14:09):
was wondering, what is it that, you know, why is
this transfer of knowledge not happening well? And actually, what
my research has been about for a lot of years
is trying to understand what prescribing decisions do we doctors
make when does it go right? And you know, it
usually does go right, but when it goes wrong, what
can we do to understand why that's the case. And
(14:30):
we even set up a not for profit organization to
kind of push out the best science to doctors so
that we're not reliant on the sales reps or the
ads or the patient's coming in waiving a magazine advertisement,
but really just trying to get the word out on
a non commercial, nonprofit way. And that's really beginning to
catch on, and there's a whole chapter about that in
(14:51):
the book as well.
Speaker 2 (14:52):
I'm so glad you said that.
Speaker 1 (14:54):
Any final thoughts things you'd like to leave with our
listeners about your book, Rethinking Medication just medications in general
before we wrap up, Doctor Jerry Avorn, Well, I think.
Speaker 3 (15:05):
Medications are great, and I don't want to leave anyone
with the impression that there is some massive national hazard
going on here. They're the product of some fantastic science,
very dedicated people, and there's also some good work that
goes on on the drug industry, not not quite as
much as they take credit for, but you know, the
companies are discovering good drugs. The people who have ANIH
funding unless it's shut down, are discovering good things. And
(15:29):
so we've got this wonderful opportunity to have people get
advantages from these great drugs. We just need to know
how to use them better, how to make them affordable,
and how to be alert to what we need to
know about them so that we can use them as
well as we possibly can.
Speaker 1 (15:44):
That is doctor Jerry Avorn, pre eminent expert on medications,
prescription medications, all types of medicines, and his brand new
book highly recommend it, Rethinking medications, truth power and the
drugs you take. It's out and available everywhere, and we
will absolutely need to do a part two with you.
I had about another five or six questions. I was
(16:07):
dying to get in, and we are playing out of time,
Doctor Jerry Avorn, Thank you so much for the generosity
of your time.
Speaker 3 (16:13):
Thank you for having me Phil. I'd be happy to
talk about this for another couple of hours.
Speaker 2 (16:17):
If you have me back, We'll take you up on that.
Absolutely
It's West Michigan Weekend from my Heart Radio. Thank you
so much for tuning in. I am so glad you
have joined us. And let's talk about medicine, specifically medications,
and if you think about that, that ties into healthcare
and maybe the health plan. And for decades, let's not
take this for granted. We've had some amazing and remarkable
(00:21):
new prescription medicines available, even if you go back about
one hundred years to penicillin and antibiotics and everything in between.
But over the decade, over the last several decades, and
this has been decades in the mazing making, the prescription
drug business has become a big complicated mess, lots of
(00:42):
money and money driving things. And that's why I'm so
pleased to welcome in this segment a real expert, the
pre eminent expert in this area, doctor Jerry Avorn, MD,
Professor of Medicine at Harvard Medical School, a senior internest
with the mess General Brigham Healthcare sit.
Speaker 2 (01:00):
That's a mouthful. He is a leading.
Speaker 1 (01:03):
Expert and researcher at Harvard to study medication use, outcomes,
cost and policies. And he's been keeping his eyes on
this issue of medical cost, what gets approved, out of
control cost, etc.
Speaker 2 (01:19):
You name it. There's a brand new book that you're
going to want to pick.
Speaker 1 (01:22):
Up, especially if you are on prescription medicines or you
want to stay on top of this. The book is
called Rethinking Medications. Just out in late April from Simon
and Schuster. Boy, doctor Jerry Avorn. That was a ridiculously
long introduction. I'm so glad you're here. Thank you so
much for joining us.
Speaker 3 (01:41):
I'm very happy to be with you, Phil, Thanks for
having me.
Speaker 1 (01:43):
Well, you've written another book, and you've written hundreds of
journal articles.
Speaker 2 (01:48):
Why did you know?
Speaker 1 (01:50):
When did you know it's time to write Rethinking Medications?
The problems that big I'm assuming?
Speaker 3 (01:56):
Well, yeah, and also it's an interesting it's not only
problems as well, so good news and nice developments, and
it seemed like a good time to kind of pull
it all together. And when I began writing it, little
did I know how incredibly complicated things would be in
our early to mid twenty twenty five, where a lot
of things we assume about medicines and healthcare kind of
(02:18):
up for grabs.
Speaker 2 (02:18):
Now they certainly are.
Speaker 1 (02:20):
And let's state perhaps the most obvious thing for the
start of this conversation as we look at rethinking medications
and the importance of just understanding the medications available to you.
Your doctor is going to prescribe things or recommend things
for you. There are a lot of reasons behind that recommendation,
(02:41):
but the bottom line I would assume doctor Jerry Avorn
is a lot of us are quite naive about the
medicines were prescribed. We might see something on TV, get
a referral from a friend. Do you think we're lazy,
ill informed, or both.
Speaker 3 (02:57):
None of the above. I think that most doctors and
most patients are really working hard to do the right thing,
and it's hard to be a patient. It's also hard
to be a doctor in terms of getting on top
of the vast amount of information that's out there. And
part of the books intent was to try and make
that somewhat more doable, because it's life and death, and
(03:21):
if we get it right, we've got fantastic medications that
can really help extend people's lives, make the quality of
life better. But if we don't get it right, whether
the we is the doctor or the patient, we can
get into a lot of trouble. So that's kind of
the goal behind the book.
Speaker 1 (03:36):
Yeah, is the broken healthcare system a part of this
issue or is it bigger than that?
Speaker 3 (03:42):
Jerry, Well, I'm afraid that we do have a healthcare
system that is working nowhere near as well as it
could in terms of people getting access to care, being
able to afford care, particularly their medications, being able to
feel like you can get help when you need it.
We are not doing as good a job in the
country as we ought to, and the hope is to
(04:04):
kind of point the way, because you know, we could
do it better. We're spending more on healthcare per person
and twice as much on medications per person than any
other wealthy country in the world, and yet our outcomes
are either average or a little below average. So we
ought to be able to do better. We got the resources,
we just need to figure out how to do it
(04:25):
a little bit smarter.
Speaker 1 (04:26):
Well, if we have the resources, then why aren't we
doing it smarter now? Is it because of the power
of big pharma or the reasons?
Speaker 3 (04:33):
Well, yeah, I think your right, Phel that the politics
is an important piece of it. That a lot of
our drug policies are driven very, very heavily by the
drug industry, and they do some very useful things, but
they're also a political powerhouse, and it's the largest lobbying
effort in the country is from the pharmaceutical industry, and
(04:54):
they tend to have their way with congress people and
people in the executive branch. On both sides of the aisle.
We've seen some really bad policies made by Democrats and
by Republicans. And yeah, when there's that many dollars at stake,
over half a trillion dollars a year, it buys a
lot of influence and a lot of pressure.
Speaker 1 (05:13):
We're speaking with doctor Jerry Avorn. His new book is
Rethinking Medications, taking a look at the whole process of
prescription medicines, especially the drug evaluation process, which you say
in the book is being seriously compromised not only by
the pharmaceutical companies, but especially right now in the times
(05:35):
we're living in the current presidential administration, maybe even by the.
Speaker 2 (05:40):
FDA and beyond that.
Speaker 1 (05:42):
Help us unpack that issue as far as the evaluation
of drugs, doctor Jerry, everyone and kind of looking in
the future a little bit, do you see this getting
worse before it gets better?
Speaker 3 (05:56):
Yeah, I'm worried about the future because what the FDA
used to be the glory of the world in terms
of its very scientific and unbiased evaluation of medicines, and
then during the AIDS crisis, there was a reform that
was really full of good intentions of let's leed drugs
out there before they're completely evaluated, because people are dying
(06:18):
and we don't have any good treatments, and so something
called accelerated approval was created as a means to get
drugs to people who were going to die otherwise. And
that was a good idea back in nineteen ninety two
when it was started. But what we've seen now is
that there's been a lot of pressure from the industry
to get drugs approved on this accelerated pathway. Even if
(06:40):
they could have done better studies, or if they could
have shown whether it really helps people, they're able to
kind of sleeze by and have drugs approve based on
only a small improvement or change in a lab test,
and then the FDA has said, okay, fine, we'll give
it accelerated approval, and then has not done the second
half which was anticipated as part of the plan, which
(07:02):
is tell the companies to now go ahead and do
the big studies to really show if it helps patients.
A lot of the companies just drag their feet sell
the drug at whatever price they choose, often a high price,
and the FDA has been really pretty bad at getting
them to follow up and actually do the studies that
we need to know. Is this just changing a lab
(07:23):
test or is it helping the patient?
Speaker 2 (07:26):
Doctor Avorn.
Speaker 1 (07:27):
It's hard to watch anything on TV without seeing pharmaceutical
drugs being advertised. It's hard to watch anything on TV
without seeing pharmaceutic drug drugs being advertised and a very
long and complicated list of potential side effects and dangers
of taking the drugs. I think you just spoke to
that to an extent, but the advertising of these prescription
(07:52):
drugs alone may be causing part of the problem as well.
Speaker 2 (07:56):
I just like to get your take on that.
Speaker 3 (07:58):
Absolutely. And you know, no other country on Earth allows
that except New Zealand, but that's a different story. But
every other country says what we set up until nineteen
ninety seven. No, these are too complicated a question to
have this be the subject of a sixty second TV
commercial with actors and colors and music and stuff. You know,
(08:19):
that's kind of degrading the whole thing, and most every
place else on earth that's not legal, but here it is.
And I think it's kind of a waste of money,
a waste of time. And the last thing that a
doctor needs is to have a patient come in saying
I saw this commercial on TV last night, Give me
that drug please. It's we could think of a lot
of better ways of spending that those tens of billions
(08:42):
of dollars that are spent on those commercials.
Speaker 1 (08:45):
I want to ask you about the and celebrities in
those commercials selling those drugs too, a lot more celebrities.
It must be money that's too hard to turn down.
I'm glad you said that. I want to ask you
about the relationship doctor Jerry Avorn. Your new book is
Thinking Medications, the relationship between a patient.
Speaker 2 (09:04):
And their primary care physician.
Speaker 1 (09:05):
Maybe they're specialists and drug recommendations. How confident can we
be that we're gaining unbiased information.
Speaker 3 (09:13):
Well, as I said, doctors really try to do the
right thing. And I don't think the problem is that
we've got doctors who are either being dishonest or venal
or dumb. It's just very, very hard to keep up
with all the information that's out there and I think
in general, and there's some suggestions in the back of
the book about ways to talk to your doctor to
try to kind of figure out is this the right
(09:36):
drug for me? And is there an affordable alternative? And
what side effect should I look out for so the
patient can really advocate for themselves and have a good
conversation with the doctor. Now, of course, the problem is
that primary care doctors are under such assault to see
people too fast, and to see too many per morning
or afternoon, and it doesn't allow enough time for that.
(09:59):
But you know, most some of them are very good,
smart folks who are trying to do the right thing.
You just kind of have to grab them, buy the
lapel for a second and say, look, if you want
me to put this into my body, I need at
least two minutes for you to explain to me what
it's for and can I afford it and what should
I look out for.
Speaker 1 (10:15):
We're speaking with doctor Jerry Avorn. He is Professor of
Medicine at Harvard Medical School, senior internest in the Mass
General Brigham Healthcare System, pre eminent expert on prescription drugs
and medications, and the new book is Rethinking Medications from
Simon and Schuster out and available wherever books are sold.
(10:36):
Conventional wisdom says, as we get older, we take more medications,
more prescriptions. But who did you write Rethinking Medications for?
I mean, people at all ages take drugs?
Speaker 2 (10:46):
Who should? Who should? Who should? Get this book?
Speaker 3 (10:49):
Well, it's really written for all ages because certainly older people,
and I'm one of them, take a lot of medications,
and that's a good thing because they're keeping us alive,
they're helping us to function. So I don't see medications
as being, you know, a negative. They're really a positive
in that sense. But there's also a section in there
about psychedelic drugs, which will probably appeal more to younger people.
(11:10):
There's a lot there about opioids, and that's all ages
get pain, and all ages need to worry about making
sure that they get their pain relieved without getting addicted.
So it's really, you know, from cradle to grave, I think,
is the audience of just normal humans.
Speaker 1 (11:26):
I love that we could do a whole other segment,
Jerry on the psychedelic drugs. Maybe I'll have you back
on that one. Would be pleased to do it.
Speaker 3 (11:33):
It's become a really interesting question, and it's very much
on everyone's minds these days.
Speaker 1 (11:38):
Well, I love it, I absolutely love it. I don't
have a lot of time left. I want to ask
some questions I've been dying to ask. Connected to you
and rethinking medications. Is there a most dangerous class of
drugs today?
Speaker 3 (11:50):
Well, the opioids have been understood to be very dangerous.
I think we're beginning to get on top of that
because I think finally doctors are understanding that, contrary to
what we were told by the opioid manufacturers, these are
not God's gift and everybody should get them whenever they want.
But they really, we now know, can have bad risks.
(12:11):
So that is certainly my candidate for a dangerous drug category.
But we're learning, We've learned, I think that to not
listen to what the manufacturers told us and to really
treat them with a lot of respect and caution.
Speaker 1 (12:23):
Widely popular class of drugs, the new weight loss drugs
will go vio zempic or lestat. There's a whole bunch
of them in their doctor Jerry Avorn, what do we
know about their long term safety?
Speaker 3 (12:35):
Well, they are astonishingly safe as far as we can
tell now. Which is a pleasant surprise. You think that
something used so widely might be causing some scary symptoms
that we don't know about. But they've been used for
enough years in enough millions of people that at least
the ones we've got now are astonishingly safe. But probably
(12:55):
is that just so damn expensive. That's their main sort
of side effect. We call that financial toxicity. But if
it weren't for the cost, I think even more people
would be able to be benefiting from them, because you know,
they do control weight, they're a good fear, you know,
preventing heart disease, kidney disease, sleep apnea. There are a
remarkable class of drugs. I just wish they didn't have
(13:17):
a list price of one thousand dollars a month.
Speaker 1 (13:20):
Doctor Jerry Avor and our guest. His book is Rethinking Medications,
available wherever books are sold, just out in late April
on Simon and Schuster. And I have so many questions.
We've got a couple of minutes left. I want to
ask you a personal question. You've been a doctor for
a long time. What lit a fire in you passion
(13:42):
for understanding medications and this area of study.
Speaker 3 (13:46):
Well, when I was a medical student that starts in
nineteen sixty nine. I was struck with the real difference
between all the really elegant science we are learning in
our classrooms over at Harvard Medical School. And then I'd
get out and see what was happening kind of in
typical practice, and it didn't always match up. You know,
there was a lot of medication used that didn't seem
to fit the science we are being taught, and I
(14:09):
was wondering, what is it that, you know, why is
this transfer of knowledge not happening well? And actually, what
my research has been about for a lot of years
is trying to understand what prescribing decisions do we doctors
make when does it go right? And you know, it
usually does go right, but when it goes wrong, what
can we do to understand why that's the case. And
(14:30):
we even set up a not for profit organization to
kind of push out the best science to doctors so
that we're not reliant on the sales reps or the
ads or the patient's coming in waiving a magazine advertisement,
but really just trying to get the word out on
a non commercial, nonprofit way. And that's really beginning to
catch on, and there's a whole chapter about that in
(14:51):
the book as well.
Speaker 2 (14:52):
I'm so glad you said that.
Speaker 1 (14:54):
Any final thoughts things you'd like to leave with our
listeners about your book, Rethinking Medication just medications in general
before we wrap up, Doctor Jerry Avorn, Well, I think.
Speaker 3 (15:05):
Medications are great, and I don't want to leave anyone
with the impression that there is some massive national hazard
going on here. They're the product of some fantastic science,
very dedicated people, and there's also some good work that
goes on on the drug industry, not not quite as
much as they take credit for, but you know, the
companies are discovering good drugs. The people who have ANIH
funding unless it's shut down, are discovering good things. And
(15:29):
so we've got this wonderful opportunity to have people get
advantages from these great drugs. We just need to know
how to use them better, how to make them affordable,
and how to be alert to what we need to
know about them so that we can use them as
well as we possibly can.
Speaker 1 (15:44):
That is doctor Jerry Avorn, pre eminent expert on medications,
prescription medications, all types of medicines, and his brand new
book highly recommend it, Rethinking medications, truth power and the
drugs you take. It's out and available everywhere, and we
will absolutely need to do a part two with you.
I had about another five or six questions. I was
(16:07):
dying to get in, and we are playing out of time,
Doctor Jerry Avorn, Thank you so much for the generosity
of your time.
Speaker 3 (16:13):
Thank you for having me Phil. I'd be happy to
talk about this for another couple of hours.
Speaker 2 (16:17):
If you have me back, We'll take you up on that.
Absolutely
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