A Prescription for Health in an Overtreated Americaby
Nortin M. Hadler, M.D.
reviewed by Mira de Vries
So states Hadler in his introduction. This is right up MeTZelf's alley. Does the book live up to its promise?"We are becoming increasingly medicalized, made to believe that all life's challenges require medical intervention. ... My primary objective in writing Worried Sick is to provide readers with the perspectives and skills necessary to advocate for themselves in the contemporary health-care delivery system."
It consists of fourteen main chapters each with a "shadow" chapter which is Hadler's way of circumventing the need for footnotes and end-notes.
In chapter 1 he posits that most of us will die around age 85. There's no point in targeting specific diseases because if we don't die from one disease, we'll die from another.
In chapter 2 he discusses surgery for clogged arteries such as bypasses or placing stents. According to him research indicates that there is no difference in longevity or quality of life between heart patients who undergo surgery and those who don't. Any benefit that some people might derive from such surgery is canceled out by the risks.
Chapter 3 is about cholesterol, blood sugar, and blood pressure. While we are bombarded with warnings that ours is too high, we keep collectively growing older, thereby exhausting funds for Social Security and Medicare. Chapter 4 has a similar message about dietary advice.
Chapters 5, 6, and 7 deal with cancers of the colon, breast, and prostate, respectively. Here the message is similar to that in Chapters 1 and 2. Most cancers are best left untreated because if they don't kill us, something else will at about the same age. Screening only leads to unnecessary and harmful treatments.
Chapter 8 is about medicalization and disease mongering.
Chapter 9 deals with aches in muscles and bones. Hadler considers these an inevitable part of life. Diagnostic tests are likely to reveal small aberrations that have nothing to do with the pain. Treatments are useless and harmful. In Chapter 10 he posits that a person's ability to cope with such commonplace pains is compromised by the need to simultaneously cope with a bad job, a bad marriage, or a bad bank account. In both chapters as well as chapter 12 he illustrates how workers' compensation schemes encourage pains in muscles and bones to be perceived as caused by injury even though they are not.
Chapter 11 proposes that we should stop calling normal signs of aging diseases.
Chapter 12, as stated above, is about the workplace and workers' compensation schemes. Blue-collar jobs are more conducive to backache, not because of the physical labor, but because the work is emotionally less satisfying.
Chapter 13 is about alternative or complementary medicine which is at least as useless as most conventional interventions, a waste of money.
Throughout most of these chapters Hadler laments that unnecessary procedures drive up the cost of health care. In the last chapter, 14, he proposes an alternative health insurance scheme that in his view would discourage useless medical interventions, or at any rate, make the person who submits to them pay for them rather than that we all share the cost. But his proposal won't work for the following reasons:
So does this book live up to its promise to equip the reader with skills to advocate for himself? It certainly provides food for thought, particularly for those who haven't been thinking about these issues much yet. Unfortunately, the language is difficult. Even the native English speaker will likely need a dictionary, and not only for medical terms. In addition to the unusual vocabulary, some sentences are not understandable even after being reread several times. The book is also limited by the number of conditions discussed, merely a fraction of the many and varied factors that cause people to seek health care services. It would have been handier to write less about more topics. Furthermore, except for in the alternative circuit, treatment decisions aren't made by the patient, they are made by the doctor. At most the patient can refuse. For this he requires a massive dose of confidence and assertiveness precisely at the moment that he is struggling with pain or a perceived life-threatening condition. And sometimes, as Hadler illustrates in the case of workers' compensation, he's not in a position to refuse.
For all his disgruntlement about waste of money, Hadler says little about psychiatry which comprises roughly half of all health care costs. Twice he mentions that new generation antidepressants are no more effective than the older ones. True, but that wrongly suggests that the older ones were effective. In chapter 8 he states:
No source or explanation whatsoever is offered for this outlandish claim of amenability to drugs, not even in the shadow chapter. In fact, this is in the shadow chapter. If Hadler is concerned about wasting money and health, he should know that mental health care is 100% useless. Worse, 1000%, because all those people disabled by psychiatry have to be cared for and financially supported for the rest of their lives. How can Hadler be so skeptical about the efficacy and safety of somatic treatments and at the same time have seemingly blind faith in psychiatric treatments?"I will ask for indulgence regarding ... affective disorders that are not predicaments of everyday life -- mood disorders that afflict without reason ... and are amenable to pharmaceutical interventions."
Towards the end of chapter 10 he slips in this ludicrous statement:
Oh come now, Mr. Hadler, you can't even find what's wrong with my back using such technical toys, how are you going to find what's wrong with my mind?"The 'mind' is no longer an abstraction. Today we can probe it with PET scanning, forms of MR imaging, and neurochemistry."
MeTZelf thanks Dr. Robert Yoho for contributing this book to our library.