A leading medical expert explains why many medications Americans take are poorly effective, overpriced, or pose unwarranted risks—and what we can do to fix that.

Groundbreaking research has given us many remarkable new medications, but the American drug regulation process, once the envy of the world, is being seriously compromised. Under pressure from the pharmaceutical industry and Congress, the FDA has been lowering its approval standards and allowing poorly effective or risky drugs to enter the market—at the same time that our prescription prices have become the highest in the world. In Rethinking Medications, Dr. Avorn explains how we got here and what we can do to ensure that our medicines are reliably effective, safe, and affordable.

Part of the problem, Dr. Avorn points out, is the power of pharma’s biggest-in-Washington lobbying clout, which influences members of Congress from both parties. Drug companies’ considerable leverage is extended by FDA’s growing dependence on fees the industry pays to get its drugs approved. Meanwhile, our highest-anywhere drug prices put needed medications beyond the reach of many patients, adding pressure to the funding of medical care for everyone. The increasingly profit-driven US health care system shapes the way doctors prescribe medications—sometimes to the detriment of patients.

Based on his decades of practice and research at Harvard Medical School and his role at the center of many of these controversies, Dr. Avorn presents compelling clinical illustrations of these issues across the medical spectrum: from cancer drugs to opioids, from treatments for rare diseases to psychedelics. Throughout, he offers practical steps that consumers, policymakers, and practitioners can take to fix these problems.