FOREWORD
by Nicholas Bachynsky, M.D., Ph.D
Orphan drugs are drugs available outside the United States but n0t
permitted within this country and they are drugs needed to treat rare
diseases or disorders affecting a small number of patients. The term
"orphan drugs" troubles me because it suggests that these drugs are
different from other substances available to doctors. The implication is
that these drugs have not been fully tested or adequately documented.
Let's put these myths to rest. First, pharmaceutical research out-
side the United States is competent, scientific, and thorough. Many
foreign drug firms have been in business longer than American phar-
maceutical companies. Second, we can adequately research the effects
of drugs used for diseases by testing small patient populations. Third, it
is not uncommon for doctors to use a drug effectively for diseases other
than the one for which it was developed. Once we learn the chemical
properties of a new drug, we can readily adapt it to new therapeutic
uses.
This book, Orphan Drugs, lists 192 generic (and 1,535 brand name)
drugs available outside the United States that have passed the scientific
tests. The Sources Directory lists 241 companies licensed or chartered
in their countries to produce pharmaceuticals. These drugs should be
readily available to doctors in the United States, but their use has not
earned FDA approval.
There was a time in history when a doctor regularly prescribed
combinations of drugs to be compounded by a pharmacist. We can still
do this, but most of us are reluctant to create our own compounds, even
though they may be the best remedies. Arbitrary government regula-
tions create an atmosphere of fear. The doctor and the pharmacist are
wary of legal repercussions from the use of an unlabelled compound
prepared without FDA approval although the chemistry works and
studies have proven that drugs in combinations are generally safer and
less costly than drugs administered separately.
The Food and Drug Administration is the governmental agency
responsible for placing restrictions on the use of pharmaceuticals in the
United States. The FDA has a history of beneficial policies, but it has an
abysmal career in its response to crises. Rather than react to scientific
evidence, too often it responds to worst-case scenarios. It tends to
impose unwarranted restrictions where a safe and effective drug ha
been used irresponsibly or implausibly and contrary to a doctor's
advice. In the classic case of tl~alidomide, a drug used worldwide as an
effective tranquilizer, the FDA banned the drug completely when it
should only have sought to prevent its administration to pregnant
women. On the other hand, there is no ban on cigarettes in spite of the
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Social and political
drugs, such as pentami
treatment of AIDS pa
obtained FDA approval i
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disease patients at 17 mc
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Although safeguarc
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the doctor should not h
special drug products
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available.
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拿到这本《无依之药》时,我本以为会是一本偏学术性的行业报告,毕竟“孤儿药”这个词听起来就带着一种专业和疏离感。然而,情节的展开却让我大跌眼镜,它巧妙地将复杂的医学伦理与人性探讨编织在了一起,读起来竟有悬疑小说的张力。作者似乎对叙事节奏有着极高的掌控力,总能在关键时刻抛出新的信息点,让你不得不一口气读下去,想知道那些身患罕见病症的主角们,究竟能否找到那线微弱的希望。我非常欣赏作者对于“希望”这个概念的处理,它不是一个简单的目标,而是一个不断被消耗、被重新点燃的过程。其中穿插的几段历史回顾,关于早期药物发现的艰辛与如今的困境对比,更是为整个故事增添了厚重感。它探讨的不仅是“药”的问题,更是“人”的问题——当个体生命被市场价值所定义时,我们该如何捍卫其固有的尊严?文字的流畅度极高,文风大气磅礴,虽然主题沉重,但阅读体验却非常引人入胜,让人在为角色的不幸感到愤慨的同时,也不由得反思社会结构的合理性。
评分我向来不太喜欢那些过于强调个人英雄主义的叙事,而《无依之药》则完全避开了这个窠臼。它的叙事基调是群像式的,展现的是一场系统性的、持久的战役,而非某位天才科学家的横空出世。书中对于早期药物研发的资金链断裂、科研人员的职业倦怠以及患者组织之间复杂联盟的描写,都展现了作者对细节惊人的掌控力。文字风格相对沉稳厚重,如同古老的史诗,叙述冷静,但蕴含的情感张力却足以让人心潮澎湃。这本书更像是一部社会病理学的研究报告,它用一个个真实或基于事实的案例,构建了一个关于稀缺资源分配的残酷模型。它没有承诺光明,也没有陷入绝望,而是以一种近乎纪录片式的客观性,展示了现实的复杂性。读完此书,我第一次深刻体会到,在医药领域,所谓的“奇迹”背后,往往隐藏着无数体制的失灵和人性的拷问。这是一部需要耐心去读,但读完后会带来巨大思考回馈的力作。
评分这本书,名为《无依之药》,初读时,我几乎被那种直击人心的无力感所攫住。它仿佛是一部晦涩的寓言,讲述着在庞大、冰冷的医疗体系中,那些被遗忘角落里的挣扎与呼喊。作者的笔触冷峻而细腻,没有歇斯底里的控诉,更多的是一种近乎田野调查般的冷静记录,却在字里行间渗透出令人窒息的现实。我印象最深的是对几位核心人物命运的描摹,他们并非传统意义上的英雄,而是被命运抛弃的普通人,他们的病痛,他们的家庭,他们的经济重担,都在这本书里被剖析得淋漓尽致。我尤其被其中关于研发成本与市场回报的讨论所震撼,那种赤裸裸的商业逻辑如何将拯救生命的初衷异化,让人不寒而栗。阅读过程中,我常常需要停下来,深吸一口气,去消化那些关于审批流程、专利壁垒以及保险覆盖范围的复杂信息,这些看似枯燥的专业术语,在作者的叙述下,却化作了压垮骆驼的最后一根稻草,构成了他们无声的抗争。这本书绝非轻松的读物,它更像是一面镜子,照出了我们这个时代在追求效率与利润的过程中,对个体生命关怀的疏忽与失衡。读完后,久久不能平静,那些人影似乎还在眼前晃动,挥之不去。
评分老实说,我对这种聚焦于社会边缘议题的书籍一直抱持着一种审慎的态度,生怕陷入矫揉造作的煽情陷阱。但《无依之药》的独特之处在于它的克制与深度。它没有滥用悲情,而是通过精心的结构设计,让悲剧自然而然地发生、蔓延。我注意到,作者在不同章节之间切换视角的手法极为高明,一会儿是心急如焚的患者家属,一会儿是疲惫不堪的研究员,再一会儿是坐在会议室里做决策的冷酷高管。这种多维度的呈现,使得我们无法简单地站队,而是被迫去理解每一个角色背后的驱动力与困境,从而对整个“孤儿药”的生态链有了更立体的认知。尤其欣赏书中对“科学与良知”之间张力的刻画,那种既要面对科学研究的严谨性,又要兼顾社会责任感的拉扯,被描述得入木三分。这本书读下来,感觉像是完成了一次漫长而艰难的社会学考察,它没有提供简单的答案,但却提出了我们这个时代必须正视的、最尖锐的问题。
评分这本书的气质非常独特,与其说它是一部作品,不如说它是一份沉甸甸的时代证词。阅读它的过程,像是在攀登一座由无数未解决的医学难题和伦理困境构成的山脉。作者的文风带着一种近乎诗意的疏离感,用词精准,结构严谨,几乎每一页都能找到值得反复咀嚼的句子。我特别被其中对于“等待”这一状态的描绘所打动。对于这些患者而言,等待新药的批准、等待临床试验的结果、等待保险公司的回复,构成了他们生命的主旋律。作者捕捉到了这种漫长等待中,人性是如何被一点点磨蚀,又是如何爆发出惊人韧性的瞬间。它不是那种让你看完拍案叫绝的书,而是那种会悄悄地在你内心深处凿出一个洞的书,让你在接下来的日子里,时不时地会想起那些被市场规律“遗弃”的生命。它成功地将宏大的社会议题,还原成了一个个鲜活的、充满温度的个体故事,读完后,我感觉自己的同理心被重新校准了一番。
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