Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) Hardcover – 15 Jun 2008
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"Case by case, Hadler exposes the excesses, the unjustified costliness, and the ineffectiveness of the present medical scene. He presents a proposal for a health-care insurance system that will increase the health of the nation, provide only effective care, and reduce costs." - Clifton K. Meador, M.D., author of A Little Book of Doctors' Rules, Med School, and Symptoms of Unknown Origin"
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Nortin Hadler's clearly reasoned argument surmounts the cacophony of the health care debate. Hadler urges everyone to ask health care providers how likely it is that proposed treatments will afford meaningful benefits and he teaches how to actively listen to the answer. Each chapter of "Worried Sick" is an object lesson on the uses and abuses of common offerings, from screening tests to medical and surgical interventions. By learning to distinguish good medical advice from persuasive medical marketing, consumers can make better decisions about their personal health care and use that wisdom to inform their perspectives on health-policy issues. -- Dieser Text bezieht sich auf eine andere Ausgabe: Paperback.See all Product Description
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Worried Sick is a follow up to Dr. Hadler's The Last Well Person. It has updated research information and written for the public at large. In this book, Dr. Hadler examines many of the common diagnoses and treatments and questions their validity and scientific basis. He shows clearly that many of them are not founded based on science, and that treatments are of questionable value, and possibly harmful.
Here is a brief overview but you really need to read the book for the whole story.
1- Heart bypass surgery and angioplasty: Dr. Hadler explains how bypass surgery has not been shown to be of any use. In fact, some patients whose chests were simply opened and closed had similar improvements in their level of pain after the surgery. However, those who had the surgery experiencing dementia (40%) and difficulty returning back to their regular jobs. Although, the efficacy of this treatment has never been proven, it and angioplasty continues to account for 500,000 procedures a year in the US.
2- Type 2 diabetes: He mentions that increase blood glucose level is an expected part of aging, and the effort to regulate blood sugar with medication has shown no effect in terms of preventing damage to the eyes or kidneys or preventing heart disease or stroke. In fact, ten years of intensive therapy offered no real advantage to 1000 middle aged hyperglycemic (high blood glucose level) people. So, why would anyone want
to be on therapy and suffer the side effects of medications that have no real benefits? He says changes in diet, weight loss, and exercise have are a much better approach. Also what is considered a high blood glucose level? Those levels are set by committees, not necessarily based on scientific medicine, but many times based on influence by pharmaceutical companies.
3. Hypertension: Dr. Hadler also points out that high blood pressure is another area where science has not proven that by lowering the mild high blood pressure one can really make a difference in preventing heart disease or damage to organs. He recommends for people who have diabetes and hypertension and are elderly to be treated, if regular exercise, weight loss, and diet modifications do not help. But, to be focused on keeping the blood pressure at 120/80 and getting medication to those who are 140/90 and higher, and who have no symptoms and are feeling well, is not supported by research. One thing research has shown is that a cheap first generation diuretic works just as well as the latest and very expensive anti-hypertension drugs.
4. Ruptured disc: He points out that the concept of ruptured disc as cause of back and leg pain was proposed some 70 years ago and should have remained there. There is no evidence that a ruptured disc causes any harm. All the spinal changes due to age detected in an MRI or CT scan are normal. Some 200 randomized studies clearly show that all the treatments ranging from spinal manipulation, shots, and surgeries are of no benefit. All studies have shown that patients who refused treatment recovered as well or better than those who were treated. He recommends taking Tylenol for the pain and discomfort and getting back into one's regular routine and job.
4. Knee and shoulder pain: he also points out that knee pain is of the same case. The current diagnoses, such as a torn meniscus or torn rotator cuff, and treatments are of no value, and perhaps the solution is to take some Tylenol fro the pain and keep going until the individual recovers, whether it's back or knee pain.
5. HRT therapy for post menopausal women: here is another area which is touted as a way of preventing heart disease and osteoporosis in women. He points out that not only this has failed, but the equipment they use for testing is not accurate most of the time, and that the medications used for it don't really work. Exercise is a better alternative. Also hip replacement surgery could easily be replaced with pinning the hip,
which is less costly with a faster recovery rate.
6- Cancer screening: Like Dr. Welch, author of Do I Need to Be Tested for Cancer, he too finds no scientific basis that screening well people for cancer has any benefit. He calls it, "looking for a very small needle in a big hay stack."
There is much more in the book that you need to read for yourself, and I highly recommend that you do. I used to trust my doctor and the medical system until I began to have back pain. Due to improper diagnoses and treatments I developed pain in my neck, legs, arms, hands, and became completely disabled. That's when I realized I needed to take charge of my own health. This is where physician and health educators like Dr. Hadler provide a great service. By the way, he is also a consultant to ABC News. You can watch his commentaries and read his writing at ABC News website.
Hadler has been making these points for some time in other works, and I think it's an important voice in the debate over health costs and medical insurance. Ultimately, Hadler claims that we should be debating not just about the efficiency of delivering health, for some the panacea for reducing its costs, but fundamentally the effectiveness of the care offered and provided. If, as Hadler claims, so many of the procedures, pharmaceuticals and gadgets foisted on the American public do little, nothing or may actually be harmful, why argue about how to better provide them, and instead, debate on whether they should be automatically included in the menu of options for which patients recruited and which insurance plans eventually pay.
My criticism of the book is that it is somewhat densely written, although Hadller's wit, sometimes expressed in sarcasm, probably evolved over time from the frustration of being a lone voice in the wilderness, makes the book more readable. However, a toned-down version could make the arguments moe accesible to the general public and perhaps give the book and its message a greater impact.
This is nonetheless a very interesting book with well-supported positions and a wealth of information on what you need to know in evaluating "recommendations" by health professionals. The last section is Dr. Hadler's proposal for creating a sustainable health care system on the bones of the old system, rather than starting from scratch, and I found that very intriguing. I wish it had been fleshed out more, but it certainly creates a very good starting point for discussions.
In sum, I recommend this book for anyone interested in how we can make informed choices for our own health care and for the health care system in this country.
James A.Garfield, M.D.
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