Many people take some kind of medication. Whether it’s a prescription designed to treat an ongoing condition or an over-the-counter pain reliever, the pills and liquids we put into our bodies are complex, and we often don’t understand their full impact – especially when we’re taking more than one.
We rely on our prescribers and on federal health agencies to tell us what we need to know. But that’s not always enough.
As the Trump administration reimagines the role of federal oversight in health matters, patients and prescribers can expect to face many challenges when it comes to understanding the efficacy of drugs and vaccines.
Jerry Avorn, a professor of medicine at Harvard Medical School, has written the new book, “Rethinking Medications: Truth, Power, and the Drugs You Take.” He says communication between patients and doctors remains the key to effective use of medications. Listen to the interview above or read the transcript below.
This transcript has been edited lightly for clarity:
Texas Standard: Your book comes out at a time of great change when it comes to how the federal government regulates and informs consumers about medicine. Tell us a little bit more about your concerns about, say, the changes we are seeing at the Department of Health and Human Services, how they might affect the drugs we take.
Jerry Avorn: Well, that’s why I put in the book – and I think it is still as relevant as when it came out a few days ago – tools that patients can use and also the doctors can use to find out what is the best evidence… That doesn’t mean that we should blow off what the FDA or the CDC says, but just to kind of be able to hold up your own end to the conversation to say, “what about this? What about that?”
But it’s a fallacy to think that somehow this is something which an individual patient or doctor, however smart they are, can somehow use their own experience and figure out what works and what doesn’t. That’s why we’ve got a lot of very dedicated and pretty smart people at FDA and at CDC working on this. They don’t always get it right, but they come very close most of the time.
And I think what we’ve got to do in these times, particularly, is to protect that function. And it’s kind of scary to me, as a doctor and as somebody who studies medications, that there are so many layoffs going on now at Health and Human Services, including the FDA, including the CDC.
These were not silly bureaucrats sitting around at a desk making mischief. These were people who were using the best available tools to find out what works, what doesn’t work, what’s safe, and the fact that so many of them have been fired in the last couple of weeks really scares the hell out of me.
One of the things, though, that is part of the public conversation around medicine and around what is appropriate treatment is a kind of maximalist language that seems to have accompanied that conversation.
If you are ignoring, say, what the CDC says or if that is not primary in your own thinking about medication, maybe you are a denialist or an anti-vaccine. And, of course, we see on the other side, you are following what some politically-led department or agency is coming up with.
Is it not possible that for lots of people very little will change in the coming years? That patients and doctors – and doctors, of course, keeping abreast of what’s happening in the medical literature – will be able to continue working together to find the right treatments, no matter what happens in Washington?
Well, you raise a really good point that, as in many things in life, extremes are almost always wrong and saying the FDA is perfect or CDC is perfect and they always get it right and you should always listen to them is probably incorrect. And saying they never get it right and they’re just a bunch of tools who aren’t very bright, that’s not right.
I think it is exactly as you just said, the patient and the doctor need to figure out a way to be able to wind their way away from both of those extremes.
But, really, if we find that the CDC or the FDA needs to do something better, then we need to give them the support and the staff. They need to do it better, not say, “no, every American is going to make up their own decision about what’s safe and what’s not safe.”
You make an interesting suggestion that patients make a “brown bag appointment” with their doctor to talk about the medications they’re taking. Can you say more about that idea?
Sure. What I suggest in the book is that it’s always a good idea for a patient – and I felt this from the doctor’s side as well – I would tell my patients, get a brown bag and put all the medicines you’re taking in it. And by all, I mean the ones that I prescribed, the one that some other doctor prescribed, the over-the-counter supplements, the herbal remedies, whatever you’re taking, just throw it in the bag and bring it in and we’ll spend some time talking about it.
And those were some of the most useful sessions I would have with patients because I would find out that they were taking stuff that I had no idea they were taking. They said, “oh, you wanted me to tell you about the drugs the other doctors prescribed?” Yes, of course. They were taking stuff I thought I had long discontinued and they said, “oh, the drug store just keeps filling the prescription.”
So it’s a great opportunity for mutual education by the doctor and the patient to just say, “what’s going into my body? Do I still need this? What’s this for? Is there another, more affordable, version of this?” And to kind of clear house and have that conversation.
And that’s something a doctor needs to be able to find time to do with a patient. And the patient needs to get the doctor to do for them.
To your point about how cuts might affect federal agencies and departments that are responsible for checking out how these medications may interact for people or what effects they may have long term, I know a lot of folks look to sources like the Mayo Clinic, for example, and hope to find a kind of Cliff Notes versions of the latest research there.
Are there good sources of information for patients wanting to do just a better job? Managing what they’re taking, including prescription and over-the-counter.
Absolutely, and that’s why I provided a list in the book of – and Mayo is on it as a matter of fact – of Mayo, Cleveland Clinic, Johns Hopkins, all put out websites that are vetted, that are responsible, that are evidence-based, that are very useful for a patient, and they’re of course written in patient language, that are very useful for a patient to be able to look at and be able to have that conversation with their doctor about what are the usual treatments for this, what are side effects, what to watch out for.
And there’s about two dozen others that I’ve listed as well that you can really rely on. It’s just kind of down-to-earth stuff and you mentioned one of several that are quite useful.
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I have to ask what prompted you to write this book in the first place. Do you think we’re heading long-term toward a new arrangement between patients and doctors or maybe patients and the medicines they take?
Well, I’ve spent the last four decades or so studying how drugs get approved, why are they so expensive, how do doctors make prescribing decisions, and how can we make all that work better. And I figured, okay, this would be a good time in my life to put all that down for the benefit of patients and of doctors and of policymakers because I think we, at least until the last several months, we were really doing pretty OK in this country.
We were the first country to really say, “let’s evaluate drugs to see if they work before people start taking them,” which was seen as a radical idea in the 1960s, and now other countries around the world have copied that.
I also think, though, that FDA has in some respects lost its way in some instances, in terms of being a little too willing to approve drugs that maybe don’t benefit patients and they’re under a lot of pressure from the drug industry to do so.
I’ve also learned a lot about how we doctors, try as we might, it’s very hard for us to get all the information we want. That’s why we set up a nonprofit to actually get that information out to doctors without any funding by any drug makers. It’s all just people who want to review the literature and make it available to patients and to doctors.
Because it can’t just be a matter of whose ads are the flashiest or who’s got the most sales reps. It ought to really be based on the evidence and, frankly, FDA needs to do a better job of evaluating that evidence and not just say, “well, we’ll give it accelerated approval and then later on maybe we’ll get around to figuring out if it works.” There’s been a bit too much of that as well.
