walkitout (walkitout) wrote,

_Prescribing by Numbers, Jeremy A. Greene

Subtitled: Drugs and the Definition of Disease

Greene covers the history of three drug categories (diuretics to reduce hypertension, antidiabetics and statins to lower cholesterol). He describes how these drugs were invented/discovered. He describes the arc of research used to motivate the creation of these drugs, justify the use of these drugs and to expand the market for these drugs. He includes occasions when unexpected research results led to the withdrawal of a drug -- and also when research results probably should have led to withdrawal of a drug but did not, and why.

Greene covers several threads of resistance to the increasing markets for these drugs. He avoids covering "scandals" because his point is that marketing and the market have a much bigger influence in the pharmaceuticals when their isn't a scandal than when there is. He asserts that paying too much attention to scandals distracts from the pervasive and unavoidable market influence in/on/of pharmaceuticals. Greene pays limited attention to the issue of negative effects on individuals who take drugs they may never personally experience any benefit from, and only mentions at the end the environmental impacts of pharmaceuticals, and the social injustice of crazy amounts of drugs for risk reduction in wealthy nations and nothing for people suffering from sleeping sickness and malaria.

This is a very wonky book. In addition to containing a lot of medical terminology, Greene assumes the reader has at least a passing awareness of basic ideas from statistics such as normal curves, standard deviations, one-tailed versus two-tailed tests. He assumes the reader is aware of scientific/medical conventions of research such as randomization, double-blind, case-controlled, cohort. He supplies limited details about things like thalidomide and the Framingham study, presumably assuming these are enough to aid the reader in recalling the rest of the story. He assumes the reader has the ability to make sense of words like nephritic (in medicine or anatomy) and deontological (in philosophy).

If you _do_ have the prerequisite background knowledge and vocabulary to make sense of Greene's language, I predict you will appreciate the clarity and conciseness of his presentation, the lean precision of his argumentation and his overall prose style. This is no chatty guy chasing down the experts and quizzing them; this is a scholar who is carefully rallying the evidence in the service of an unobvious but nevertheless extremely important thesis. Every once in a while, he lands a zinger -- like when he points out that by exhorting careful monitoring and treatment of prehypertension, public health folk are stuck pursuing an asymptomatic risk factor which leads to another asymptomatic risk factor, two steps away from any hard disease. But generally speaking, this isn't a funny or snarky book.

I really liked it. I'm planning on keeping my copy.
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