- Hardcover: 312 pages
- Publisher: The University of North Carolina Press (15 Jun. 2008)
- Language: English
- ISBN-10: 0807831875
- ISBN-13: 978-0807831878
- Product Dimensions: 24.2 x 17.3 x 3 cm
- Average Customer Review: 5.0 out of 5 stars See all reviews (2 customer reviews)
- Amazon Bestsellers Rank: 1,711,945 in Books (See Top 100 in Books)
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"
From the Inside Flap
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: Audio CD.See all Product description
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Most Helpful Customer Reviews on Amazon.com (beta)
/ -- TOO NUCH MEDICAL JARGON & SARCASM --
Let's start with the language he uses, lots of medical terminology, some explained, some not explained. He also can't resist throwing in plenty of sarcasm about the wrong practices of his colleagues that often left me unable to grasp his actual point. Between wading through the medical language and trying to figure out who or what institution he was lambasting, I frequently found myself confused.
I wish he had plainly stated his idea/opinion at the beginning of each new section, then delved into the often voluminous data that was supposed to prove his point. In plain English.
He also uses an unusual format, with each regular chapter having a "shadow" chapter intended to provide more backing for his position. I found though that both regular and shadow chapters seemed to have a lot of the same kind of content. I think he wanted to use the chapter to tell his story of what needs fixing and why, then use the shadow chapter to give more of the actual studies and data that are the basis for his reasoning. However, I don't think he really succeeded with this format. Understanding his points is an unnecessarily difficult chore for the reader.
/ --- WHAT IS ILLNESS? ---
Dr. Hadler has some interesting insights into illness that go to the issue of when we should seek medical care. He says that 75% of what we perceive as illness is really what he calls a "social construct" or could be deemed "artificial epidemic" (an insight from Rudolph Virchow over 100 years ago). People living under poor conditions and working at jobs and tasks they dislike are more likely to become "sick" than people living in "advantaged" situations. In plain language, people whose lives are characterized by wealth and social advantage will be "healthier" than poor people. It follows from this truth that medical measures such as drugs and surgery will not "cure" people whose main problem is their socioeconomic status.
Dr. Hadler is especially tough on the idea of work-related "illness" that society has decided to "compensate" with such measures as Workman's Compensation. People claiming backaches, sore arms, wrist pain and the like are really unhappy with their work. Not that Dr. Hadler is unsympathetic; he does not say they do not actually hurt or are "making it all up," but that they are unable to cope with what are really the ordinary aches and pains of life.
More advantaged people also have backaches, headaches and creaky knees, but they continue on with their lives, tuning out their pains and waiting for them to go away, which, Dr Hadler tells us, they generally do. What I glean from this is that there is no need to visit the doctor because you have one of these "ordinary" conditions (backache, headache, pains in your knees, hips, etc). Nothing the doctor can do will take these pains away, but time WILL take them away and we should all just cope in the meantime.
I think of all the times we are all urged to "see your doctor" about this or that.'' I am old enough (old enough for Medicare) to have come to pretty much the same conclusion as Dr. Hadler, but I still find it difficult sometimes to know where the line is between "ordinary" and "might be a symptom of something worse." I admit I avoid doctors partly because the contact with the medical establishment is usually unpleasant and almost always ridiculously expensive (even if I'm not actually paying for it myself -- SOMEONE is paying for it.)
/ -- TREATMENTS THAT DON'T WORK --
Dr. Hadler is big on quoting studies -- those "randomized" groups of people who are followed over time, divided into two groups, those getting the treatment and those getting a placebo (something that looks like the treatment but isn't). He thinks we spend too much time on the cost (which he readily admits is excessive) rather than the effectiveness of what doctors do. He also doesn't think much of "efficiency" as a way to improve our health care. If it's inexpensive and efficient, but does not actually work, then it is still a waste of money. It is even worse than just a waste of money if the treatment causes actual harm or carries a risk of harm. Those studies or "clinical trials" of groups of people can shed light on whether a treatment actually provides benefit, or not.
I am glad he included screening tests, which seem to constantly proliferate and be urged on us by various medical establishments and big charities. I am personally convinced most of these tests, some invasive and harmful, are just a money-maker for the people who promote them. Lots of studies have been done (and Dr Hadler gives a good summary of them) on screening mammograms and the conclusion is that mammograms do not save lives, but they do result in lots of medical treatment on women who might never have had any impact from the tiny spot seen on a mammogram. (A really good book on this is Dr Gilbert Welch's book, Overdiagnosed.)
Dr. Hadler barely mentions the actual harm from mammograms in the form of unnecessary invasive biopsy and surgery, and from the radiation from each view of each mammogram session. Radiation harm is cumulative. Obviously, doing mammograms is a huge money-maker for companies that make the equipment and for the personnel involved in their use, but of what benefit to women? Isn't it time we woke up to the fact that the supposed life-saving efficacy of these tests might just be flim-flam?
Dr. Hadler is pretty hard on the Cardiologists, with their angioplasty, catheterizations and stents. None of these, he tells us, prolong life. Neither does he think obsessing over your cholesterol will reduce your chances of heart attack or stroke. All kinds of really expensive procedures a Cardiologist might recommend are mostly useless and hold the possibility of causing you harm. Both my husband and I have been to a Cardiologist in the past and I came to the conclusion that nothing done for either of us had any benefit, but of course, my own experience is anecdotal. Dr. Hadler has all the data, in this book.
/ -- YOUR NATURAL LIFESPAN: ABOUT 85 YEARS
Dr. Hadler goes against the philosophy of "doing everything possible" to save a life, which many advocate. He boldly states that the human lifespan is about 85 years, and we all need to face the fact that sometime around our 85th birthday (if we are lucky enough to last that long) our biological clock has run out. There is not much point in endless medical intervention, or doing mammograms to "save" us from breast cancer. These interventions are costly and futile. SOMETHING is going to get us, so fighting each possibly fatal condition we may have serves no purpose except to make profit for the medical establishment. On this, I agree completely with Dr. Hadler. Sometimes, we get a longer lifespan, of course (my mother is still alive and alert at age 96), but the point is to stop doing screening tests, stop taking medications that are supposed to reduce your "risk" of some disease or other and eliminate surgery for conditions of aging. Accept your own mortality.
/ -- WHAT ABOUT "ALTERNATIVE" MEDICAL SYSTEMS? --
Not surprisingly, Dr. Hadler does not think highly of alternative medical systems like Chiropractic, Acupuncture, Naturopathy or even Physical Therapy. Here, I think he protests too much. I found it interesting that studies show people are more likely to feel they got benefit from Chiropractic care than from the treatments of an MD. Dr Hadler seems to think this is because the Chiropractor spends more time with them and explains what he is doing. Gosh! Why don't MDs do more of that?
I don't want my social problems "medicalized" into phony diseases (like fibromyalgia and osteopenia, two targets of Dr. Hadler's wrath), but I do want some kind of medical equality in this country, with everyone having the same access to needed heathcare, and I don't see it. Nor do I think Dr. Hadler should be complaining about having to pay (in taxes or insurance) for treatments others get that he thinks are ineffective unless he includes all the things doctors do to wring more money out of us poor "patients" (I really don't like that word!). Well-insured patients are going to get more medical care (effective or not) than the underinsured or uninsured, and that runs up the cost for all of us. Randomized clinical trials are not practical for every treatment method, and some of these "alternatives" may impart some unmeasured benefit. I can cite one from my experience: Vitamin E seemed to be a big help for me with menopause symptoms.
/ -- SO WHAT ARE WE TO DO TO MAINTAIN GOOD HEALTH? --
Dr. Hadler discounts so much of what passes for medical treatment in the US that it leaves me wondering what he wants most of us to do. I have long felt that medical care provides the absolute worst value for the money of anything we spend money on in this country. I have put all my frustrations and anger (and there is lots of it!) with the so-called "health care system" into a long rant linked off my website, theseekerbooks.com. I appreciate that Dr Hadler is willing to take on his own profession and point out their numerous sins. He, with his medical credentials and honors, can obviously make more difference than I can. He may be right that a lot of "sickness" is about social conditions, and I applaud him for speaking out about that. But I do think he is a bit over the top in just dismissing any sort of medical intervention for people suffering with "aches and pains."
/ -- HOW DO WE FIX IT? --
Dr. Hadler ends his book with a proposal about how to reform health care delivery in the US. He seems to think any kind of take-away in terms of what's covered by insurance (public or private) will be seen as "rationing." He DOES want to limit coverage to treatments with some proof of effectiveness, and that would eliminate most of the so-called "preventive care" items that are currently covered by Obamacare, like mammograms, colonoscopies and prostate screening. I think coverage for these expensive but ineffective screening programs SHOULD end, for the reasons Dr Hadler gives. They line the pockets of big industries, but do not help us ordinary people with our pathetically poor coping skills. Dr. Hadler does want to devote part of the money going into his proposed health care plan to letting people choose and fund ways to improve their social environment, presumably thereby improving their coping skills. Money not spent on medical stuff would flow into that fund, thus keeping critics from charging that the plan was trying to "save money" by not paying for their colonoscopy or whatever.
Fixing our dysfunctional system of delivering health care will not be easy and will be opposed by the Big Money interests who profit so handsomely off our current system. Healthcare is always listed as a "growing" industry, but shouldn't the goal of any healthcare system be providing everyone with effective services and not be all about profit?
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.
he takes the medical school oath phrase "first do no harm" to heart.
When I read his book, I felt that someone was secretly reading my mind
and published my suspicions about our healthcare today. And it came with
references. I would love to have copies of this book to hand out to people
who follow the screening tests, yearly physical exams, etc public recommendations religiously and believing that
everything can be "prevented" or "cured."
I am looking forward to his other publications, although I do not dare voice
my opinion in public, as these healthcare beliefs have become as volatile in a conversation,
such as if you want to not have argument at a party, do not bring up
religion or politics- well now you can add "preventive healthcare" as well.
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