Product Description

Product Details

• Amazon Sales Rank: #247637 in Books
• Published on: 2007-09-18
• Released on: 2007-09-18
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 352 pages

From Publishers Weekly
Starred Review. Contrary to Americans' common belief that in health care more is more—that more spending, drugs and technology means better care—this lucid report posits that less is actually better. Medical journalist Brownlee acknowledges that state-of-the-art medicine can improve care and save lives. But technology and drugs are misused and overused, she argues, citing a 2003 study of one million Medicare recipients, published in the Annals of Internal Medicine, which showed that patients in hospitals that spent the most were 2% to 6% more likely to die than patients in hospitals that spent the least. Additionally, she says, billions per year are spent on unnecessary tests and drugs and on specialists who are rewarded more for some procedures than for more appropriate ones. The solution, Brownlee writes, already exists: the Veterans Health Administration outperforms the rest of the American health care system on multiple measures of quality. The main obstacle to replicating this model nationwide, according to the author, is a powerful cartel of organizations, from hospitals to drug companies, that stand to lose in such a system. Many of Brownlee's points have been much covered, but her incisiveness and proposed solution can add to the health care debate heated up by the release of Michael Moore's Sicko. (Sept.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist
*Starred Review* Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is. In a step-by-step deconstruction of America's improvident health-care system, Brownlee sheds light on events, attitudes, and legislation in the twentieth century's latter half that led to this economic nightmare. With the skill of a crack prosecuting attorney, she cites specific cases of physician and hospital fiscal abuse. Her aim is broad but not scattershot as she hits not just docs and hospitals but private insurers, Medicare, patients, medical device manufacturers, and pharmaceutical companies by, for instance, quoting a pharmaceutical salesperson who confesses financing a physician's swimming pool to get the doc to write more prescriptions. She is not all bad news, though, for she posits models that could be adapted to create a nationwide health-care system that conceivably could staunch the current fiscal hemorrhaging. If only. Chavez, Donna

Review

Customer Reviews

HELP! - Healthcare Reform Needed!!!!!

Read this book.

If you are in the American healthcare system, this is the single most important book you will ever read. If you are in a healthcare system that is moving towards "privatization" or "free market reform", this may be the most important book you will ever read. If you are a behavioral scientist interested in the role of behavioral factors in medical populations, this is the most important book you will ever read.

A science journalist with a real science background (an M.S. in Biology) and now a Fellow at the New America Foundation, Brownlee has brought together many strands of research to provide us with a picture of the core dilemma in the american health care system - why do we spend so much more than other industrialized countries while not producing better outcomes? At 16% of Gross Domestic Product (and climbing), the American healthcare system is 60-100% more expensive than any other industrialized country and yet we do not live as long as citizens there. Where all these countries cover 100% of their citizens, the American system leaves about 15% of its population (about 47 million people) uncovered at any one time (and even more if you include loss of coverage for extended periods, but not a whole year). Fifty percent of bankruptcies in the U.S. are due to medical bills. Americans avoid switching jobs for fear of losing coverage for pre-existing conditions. The U.S. manages to achieve these colossal failures while still expending 62% of all costs through the government (if civilian government employee's coverage is included as part of the government supported costs).

While there are many contributing problems (profiteering by insurance and drug companies, a system which rewards physicians for doing more rather than just what is proven effective, malpractice anxiety leading to defensive practice, lack of coverage for primary preventive and mental health care which could avoid more expensive emergency care, etc.), Brownlee demonstrates that the core issue is a lack of clinical research to guide physician's decision-making. Where ambiguity exists (and it exists in up to 80% of healthcare), variability in "standard" care is great, and unnecessary care and expense mounts. As a comic strip character once observed: "We have met the enemy, and he is us."

Starting with the studies by John Wennberg and the Dartmouth Center for Evaluative Clinical Sciences, Brownlee reviews the high level of variability (up to seven fold) in the use of various procedures across the U.S. Wennberg's observation is that in U.S. healthcare, "geography is destiny". The kind of treatment you receive depends upon where you live, not what your illness is. And the characteristic most strongly associated with unnecessary care is the number of specialists. If we build it, they will come. The normal operation of a free market is distorted in healthcare by: socialization of costs; the desperation of patients and families; the vast difference between "buyers" (patients) and "sellers" (practitioners, hospitals, drug companies) in understanding what actually works and the tradeoffs in outcomes; and the placebo effect and spontaneous remission. But isn't it part of our duty to protect patients from unproven, and potentially harmful, interventions? If outcomes were improved in the more aggressive geographic areas of the country we might be able to claim that the less costly areas are undertreated, but they are not. In fact, in most comparisons, patients are, if anything, worse off with the more aggressive care. Remember that Hippocratic dictum: "Primum, non nocere" (First, do not harm)? The propensity of U.S. healthcare is to "do something" rather than accepting the patient's status as perhaps better than the potential harm occasioned by aggressive intervention. For those of us raised in the era of "If it might help, do it", this is tough medicine to swallow. But it is necessary medicine.

Brownlee acquaints the reader with many of the more egregious failures of the system: back surgery for chronic low back pain; mastectomy (vs lumpectomy) in breast cancer; bone marrow transplantation in breast cancer; PTCA for event, or even chest pain, reduction in coronary heart disease; fen-phen for weight loss; carotid
endarterectomy in asymptomatic patients; surgery for prostate cancer, etc.

One implication of all this is that the highest priority for medical research should be clinical trials that clarify the effectiveness, safety and efficiency of various treatments. The hostility of the NIH to this task is captured by a quote from its director: "We don't do Coke versus Pepsi". Fine. If the NIH is uninterested in improving American healthcare (it's congressionally mandated mission), defund the NIH and put the money into the Agency for Healthcare Policy and Research - the folks who blew the whistle on back pain surgery and were subsequently assaulted by the Orthopods bribing Congress. The priorities for public funding should exactly answer us about "Coke versus Pepsi", because that's where lives are won or lost. Cellular, subcellular and genetic research has such a low rate of clinical payoff that it ought to be the minor theme.

Protect yourself--and the ones you care about--by reading this book!!!
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"[This book] is an exploration of three simple questions:

(1) What drives unnecessary health care?
(2) Why should we worry about it?
(3) And once we understand how pervasive it is in American medicine, how can we use that knowledge to create a better system?"

The above is found in this stunning, eye-opening book authored by medicine, health care, and biotechnology and award-winning journalist Shannon Brownlee.

Note that even though this book concentrates on the American healthcare system, what it says can be applied to the Canadian and European systems as well.

People familiar with the problems in healthcare will be familiar with some of the contents of this book. What they won't be familiar with is the true-life patient and whistle-blower stories (many of them ending up tragically) that Brownlee discusses to drive home the points she makes.

Almost every page has something interesting on it. I will provide a sample sentence from each chapter of this gripping book (these are just the tip of the iceberg):

(1) "As research would show over the coming decades, stunningly little of what physicians do has ever been examined scientifically, and when many treatments and procedures have been put to the test, they have turned out to cause more harm than good."
(2) "Every patient admitted to a hospital risks being hurt or even killed by the very people who wish to help her."
(3) "After blowing the whistle on the hospital and its specialists, he would lose practically everything he valued, his medical practice, his family, and his home."
(4) "The supply of medical resources, rather than the underlying needs of patients, is determining how much medical care they get."
(5) "How is it that a dangerous, highly experimental treatment came to be given to thousands of women before it had been adequately tested?"
(6) "Even as the number of [medical] imaging tests [X-ray, CT, MRI] is going up, numerous studies suggest that all those pictures are not nearly as effective at improving diagnosis as many doctors--and patients--tend to think."
(7) "On Thursday, three weeks after Justin swallowed his first antidepressant [prescribed to him by a university doctor], his roommate walked into their apartment to find his friend dead [of suicide]."
(8) "The drug company representative, or drug rep, usually [is] a handsome young man or shapely young woman who has been recruited more for his or her good looks and outgoing personality than for his or her aptitude for science or medicine."
(9) "The more specialists involved in your health, the more likely it is that you will suffer from a medical error, that you will be given care you don't need and be harmed by it."
(10) "The Institute of Medicine estimates that only 4 percent of treatments and tests are backed up by strong scientific evidence; more than half have very weak evidence or none."

Finally, if you want to seriously investigate this topic more, I recommend two classic books:

(1) "Confessions of a Medical Heretic" by an American doctor.
(2) "The Medical Mafia" by a French-Canadian doctor. (This conscientious doctor lost her medical license for having written this book.)

In conclusion, if your satisfied with the medical system, then there is no reason to read this book. But if you're not and what to protect yourself and your loved ones, then read this well-researched book and prepared to be stunned!!

(first published 2007; introduction; 10 chapters; main narrative 305 pages; acknowledgements; notes; index; a note on the author)

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Easy reading, Hard thinking
This well-written book is easy to read and raises some big questions about what we really want from our health care system. The author has obviously done a lot of research and looks at the history of how we got here, but she also brings it all to life with lots of stories and real examples. I'm a nurse, but I learned new things from reading this and found that it gave me some new perspectives on my work and the experiences of my patients. Definitely recommend it to anyone concerned about the cost and quality of our American health care system.