Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.

Making Medicines is a concise, chronological discussion of the history of therapeutics and pharmacy from the Egyptians through to the present day. It focuses on the discovery and uses of medicines to treat illness through the ages, and the evolving role of the pharmacist. Each chapter is contributed by an expert in the period or field, and illustrates how wider social, political and economic developments have influenced drug development and shaped pharmacy practice.The book has two colour-plate sections illustrating how pharmacy has developed over the centuries. Numerous photographs are also included in the text.Written by an expert in the field, this book will appeal to pharmacists and pharmacy students, as well as to other healthcare practitioners and medical historians.

Pharmacy has become an integral part of our lives. Nearly half of all 300 million Americans take at least one prescription drug daily, accounting for $250 billion per year in sales in the US alone. And this number doesn't even include the over-the-counter medications or health aids that are taken. How did this practice become such an essential part of our lives and our health? A Brief History of Pharmacy: Humanity's Search for Wellness aims to answer that question. As this short overview of the practice shows, the search for well-being through the ingestion or application of natural products and artificially derived compounds is as old as humanity itself. From the Mesopotamians to the corner drug store, Bob Zebroski describes how treatments were sought, highlights some of the main victories of each time period, and shows how we came to be people who rely on drugs to feel better, to live longer, and look younger. This accessible survey of pharmaceutical history is essential reading for all students of pharmacy.

Based on extensive archival research in Peru, Spain, and Italy, Making Medicines in Early Colonial Lima, Peru examines how apothecaries in Lima were trained, ran their businesses, traded medicinal products, prepared medicines, and found their place in society. In the book, Newson argues that apothecaries had the potential to be innovators in science, especially in the New World where they encountered new environments and diverse healing traditions. However, it shows that despite experimental tendencies among some apothecaries, they generally adhered to traditional humoral practices and imported materia medica from Spain rather than adopt native plants or exploit the region’s rich mineral resources. This adherence was not due to state regulation, but reflected the entrenchment of humoral beliefs in popular thought and their promotion by the Church and Inquisition.

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

Improving and Accelerating Therapeutic Development for Nervous System Disorders is the summary of a workshop convened by the IOM Forum on Neuroscience and Nervous System Disorders to examine opportunities to accelerate early phases of drug development for nervous system drug discovery. Workshop participants discussed challenges in neuroscience research for enabling faster entry of potential treatments into first-in-human trials, explored how new and emerging tools and technologies may improve the efficiency of research, and considered mechanisms to facilitate a more effective and efficient development pipeline. There are several challenges to the current drug development pipeline for nervous system disorders. The fundamental etiology and pathophysiology of many nervous system disorders are unknown and the brain is inaccessible to study, making it difficult to develop accurate models. Patient heterogeneity is high, disease pathology can occur years to decades before becoming clinically apparent, and diagnostic and treatment biomarkers are lacking. In addition, the lack of validated targets, limitations related to the predictive validity of animal models - the extent to which the model predicts clinical efficacy - and regulatory barriers can also impede translation and drug development for nervous system disorders. Improving and Accelerating Therapeutic Development for Nervous System Disorders identifies avenues for moving directly from cellular models to human trials, minimizing the need for animal models to test efficacy, and discusses the potential benefits and risks of such an approach. This report is a timely discussion of opportunities to improve early drug development with a focus toward preclinical trials.

An herbal medicine making book and formulary with its roots in original herbalism designed for home medicine makers, herbal schools and small manufacturers.

A History of the Medicines We Take gives a lively account of the development of medicines from traces of herbs found with the remains of Neanderthal man, to prescriptions written on clay tablets from Mesopotamia in the third millennium BC, to pure drugs extracted from plants in the nineteenth century to the latest biotechnology antibody products. The first ten chapters of the book in PART ONE give an account of the development of the active drugs from herbs used in early medicine, many of which are still in use, to the synthetic chemical drugs and modern biotechnology products. The remaining eight chapters in PART TWO tell the story of the developments in the preparations that patients take and their inventors, such as Christopher Wren, who gave the first intravenous injection in 1656, and William Brockedon who invented the tablet in 1843. The book traces the changes in patterns of prescribing from simple dosage forms, such as liquid mixtures, pills, ointments, lotions, poultices, powders for treating wounds, inhalations, eye drops, enemas, pessaries and suppositories mentioned in the Egyptian Ebers papyrus of 1550 BCE to the complex tablets, injections and inhalers in current use. Today nearly three-quarters of medicines dispensed to patients are tablets and capsules. A typical pharmacy now dispenses about as many prescriptions in a working day as a mid-nineteenth- century chemist did in a whole year.

To explore the role of the National Institutes of Health (NIH) in innovative drug development and its impact on patient access, the Board on Health Care Services and the Board on Health Sciences Policy of the National Academies jointly hosted a public workshop on July 24â€"25, 2019, in Washington, DC. Workshop speakers and participants discussed the ways in which federal investments in biomedical research are translated into innovative therapies and considered approaches to ensure that the public has affordable access to the resulting new drugs. This publication summarizes the presentations and discussions from the workshop.