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If you believe that the latest blockbuster medication is worth a premium price over your generic brand, or that doctors have access to all the information they need about a drug’s safety and effectiveness each time they write a prescription, Dr. Jerry Avorn has some sobering news. Drawing on more than twenty-five years of patient care, teaching, and research at Harvard Medical School, he shares his firsthand experience of the wide gap in our knowledge of the effectiveness of one medication as compared to another. In Powerful Medicines, he reminds us that every pill we take represents a delicate compromise between the promise of healing, the risk of side effects, and an increasingly daunting price. The stakes on each front grow higher every year as new drugs with impressive power, worrisome side effects, and troubling costs are introduced. This is a comprehensive behind-the-scenes look at issues that affect everyone: our shortage of data comparing the worth of similar drugs for the same condition; alarming lapses in the detection of lethal side effects; the underuse of life-saving medications; lavish marketing campaigns that influence what doctors prescribe; and the resulting upward spiral of costs that places vital drugs beyond the reach of many Americans. In this engagingly written book, Dr. Avorn asks questions that will interest every consumer: How can a product judged safe by the Food and Drug Administration turn out to have unexpectedly lethal side effects? Why has the nation’s drug bill been growing at nearly 20 percent per year? How can physicians and patients pick the best medication in its class? How do doctors actually make their prescribing decisions, and why do those decisions sometimes go wrong? Why do so many Americans suffer preventable illnesses and deaths that proper drug use could have averted? How can the nation gain control over its escalating drug budget without resorting to rationing or draconian governmental controls? Using clinical case histories taken from his own work as a practitioner, researcher, and advocate, Dr. Avorn demonstrates the impressive power of the well-conceived prescription as well as the debacles that can result when medications are misused. He describes an innovative program that employs the pharmaceutical industry’s own marketing techniques to reduce use of some of the most overprescribed and overpriced products. Powerful Medicines offers timely and practical advice on how the nation can improve its drug-approval process, and how patients can work with doctors to make sure their prescriptions are safe, effective, and as affordable as possible. This is a passionate and provocative call for action as well as a compelling work of clear-headed science.
A pioneer in women's medical care, Penny Budoff has become increasingly convinced that women need medical care and health information that is right for them, not watered down versions of what is right for men -- and with over thirty years of experience, she's ready to provide it. Today we see daily headlines trumpeting the results of the efforts begun by her and the other physicians concerned specifically about women: headlines about heart disease in women, breast cancer, Alzheimer's, hormone replacement therapy, osteoporosis, sexuality -- and, yes, menopause, the once unspoken word. These are the issues of her newest book, incorporating Dr. Budoff's own vast experience and the expertise of additional physicians specializing in each area of womens health. In this one volume, the reader can learn the most up-to-date knowledge about what to expect in one's middle years: why hormone replacement therapy can solve the side effects of menopause and givea woman freedom from osteoporosis, heart disease and even Alzheimer's disease; why natural estrogens and vitamins are essential; why the brain is our most important organ -- and can be kept healthy for decades; why cervical cancer is a sexually transmitted disease. All this information is accessible in this one valuable book.
For anyone who treats postmenopausal women, this latest edition of Rogerio Lobo's classic work combines the best from two well-known references: Menopause, and the second edition of Treatment of the Postmenopausal Woman. By adding significant discussions of the basic science behind menopause, it is possible to objectively assess the clinical value and limitations of current approaches to treatment and provide a basis and rationale for strategies that will result in better individualized and specialized care. Not only does the third edition discuss diagnosis and treatment of menopause but it covers biological, anatomical, physiological, pathobiological, and pharmacological aspects as well bringing together, in one source, all of the information needed to understand and treat postmenopausal conditions. Over 50% new material representing the vast amount of information available since the Women's Health Initiative (WHI) clinical trials were completed making this the most up-to-date reference on postmenopausal women Includes several new sections on comparisons between clinical trials and observational data, urology, and pelvic support Each section is preceded by a preface to put the area into context with many chapters having suggested treatment regimens
Using Science to Improve the BLM Wild Horse and Burro Program: A Way Forward reviews the science that underpins the Bureau of Land Management's oversight of free-ranging horses and burros on federal public lands in the western United States, concluding that constructive changes could be implemented. The Wild Horse and Burro Program has not used scientifically rigorous methods to estimate the population sizes of horses and burros, to model the effects of management actions on the animals, or to assess the availability and use of forage on rangelands. Evidence suggests that horse populations are growing by 15 to 20 percent each year, a level that is unsustainable for maintaining healthy horse populations as well as healthy ecosystems. Promising fertility-control methods are available to help limit this population growth, however. In addition, science-based methods exist for improving population estimates, predicting the effects of management practices in order to maintain genetically diverse, healthy populations, and estimating the productivity of rangelands. Greater transparency in how science-based methods are used to inform management decisions may help increase public confidence in the Wild Horse and Burro Program.
Now in a much-anticipated two-volume new edition, this gold-standard reference stands as the most comprehensive and authoritative text on equine reproduction. Serving theriogenologists, practitioners and breeders worldwide as a one-stop resource for the reproductive assessment and management of equine patients, Equine Reproduction, Second Edition provides detailed information on examination techniques, breeding procedures, pregnancy diagnosis and management, reproductive tract diseases and surgery, and foaling. A companion website offers hundreds of images from the book in color. For the Second Edition, the stallion, mare and foal sections have been thoroughly updated and revised to include the latest information on every subject. New topics include discussion of nutritional and behavioral factors in the broodmare and stallion, parentage testing, fetal sexing and the health and management of older foals, weanlings and yearlings. Additionally, this outstanding Second Edition features a new section on assisted reproductive techniques, including detailed information on artificial insemination, in-vitro fertilization, embryo transfer and technology.
Over 65 million American adults have high blood pressure, defined as 140/90. Over 40 million more are ôpre-hypertensiveö defined as pressures over 120/80. Anti-hypertensive drugs are the third most common prescriptions written, only after cholesterol-lowering and pain relief. These toxic dangerous drugs merely cover up the symptoms, while leaving the causes ignored. One third of all American adults suffer from high blood pressure, and many of them go undiagnosed. This is not merely a Western phenomenon, but a worldwide one that affects poor rural people as well. Cardiovascular heart disease (CHD) is the biggest killer of all worldwide. Hypertension is the most prominent cardio-vascular condition of all. It does not need to be this way at all. This epidemic is completely unnecessary and easily avoided. High blood pressure is a major cause of stroke, heart attacks, congestive heart failure, kidney disease, and artery disease among other conditions.
A unique clinical focus makes Consultative Hemostasis and Thrombosis, 3rd Edition your go-to guide for quick, practical answers on managing the full range of bleeding and clotting disorders. Emphasizing real-world problems and solutions, Dr. Craig S. Kitchens, Dr. Barbara A. Konkle, and Dr. Craig M. Kessler provide all the clinical guidance you need to make optimal decisions on behalf of your patients and promote the best possible outcomes. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. Efficiently look up concise descriptions of each condition, its associated symptoms, laboratory findings, diagnosis, differential diagnosis, and treatment. Get the latest information on hot topics such as Disseminated Intravascular Coagulation, Thrombophilia, Clinical and Laboratory Assessment and Management, Thrombotic -Thrombocytopenic Purpura, and Heparin-Induced Thrombocytopenia. Apply today’s newest therapies, including those that are quickly becoming standard in this fast-changing field. Meet the needs of specific patient groups with a new chapter on Bleeding and the Management of Hemorrhagic Disorders in Pregnancy and an extensively updated chapter on Thrombosis and Cancer. Zero in on key information with a new user-friendly design, and all-new full-color format, abundant laboratory protocols, and at-a-glance tables and charts throughout.