A conversation with Dr. Jerry Avorn about drugs and the drug industry

Americans spend more than $300 billion a year on prescription drugs. How we use these drugs, and how effective they are, have become important subjects for public health researchers. A leader in this area is Dr. Jerry Avorn, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. Avorn is the author of numerous articles and the book Powerful Medicines.

Dr. Jerry Avorn

For an article in the Harvard Health Letter, editor Peter Wehrwein spoke with Avorn about generic drugs, the pharmaceutical industry, the high cost of cancer drugs, and more. Here’s an excerpt from their conversation.

PW: We get a lot of questions from readers about generic drugs and whether they really are just as good as brand-name drugs. Are they?

JA: Yes they are. Generics are often made by the same companies that make the branded products. And if they aren’t, they are usually made by equally large companies that the FDA subjects to the same degree of quality control as brand-name manufacturers. We are collectively wasting billions of dollars on brand-name drugs when we can buy generics that are just as safe and effective, for as little as $4 a month.

PW: We also get questions about the side effects of statins. Do you think they have been downplayed?

JA: Statins have prevented enormous amounts of sickness and death from heart disease; they are fantastic drugs. But it’s also probably fair to say that we are not as good as we should be about studying side effects that don’t land people in the hospital—or kill them. I think we have a good handle on statins and rhabdomyolysis, the muscle breakdown that can be fatal. But I don’t think we have studied as carefully as we should have the extent to which statins sometimes make people ache. And making tens of millions of people ache — that’s not nothing.

PW: Are you optimistic or pessimistic about the future of medications and their regulation?

JA: I am optimistic. The examples of what happened with Vioxx and several other problematic drugs have had a bracing effect on how we understand and study medications that is analogous to the bracing effect that thalidomide had on drug regulation in the 1960s. The other thing that gives me hope is that we have begun to pay more attention to the way existing drugs are used — and not used. The next big dent in heart disease, diabetes, and hypertension may come not from a new blockbuster drug but from understanding better how we can get people to take their medications and help them afford them.

The Harvard Health Letter is a general interest health and medical newsletter published monthly by Harvard Medical School.