The Last Well Person: How to Stay Well Despite the Health-Care System

+++++ Answer true or false to these ten statements: (1) Cardiovascular surgery clearly and unequivocally benefits the patient. (2) Even though obesity (which is unhealthy) is on the rise in America, American life expectancy is increasing. (3) There are very reliable methods for screening that spares us the risk of dying from colorectal cancer before our time. (4) Mammography is of much value to the women screened. (5) Prostate gland screening for males doesn't work. (6) It is abnormal to live two years without a backache. (7) One of the potentially dangerous acts physicians perform is to take a "history" from a patient. (8) Bone thinning is an insidious illness. (9) Psychological and social stress is not all bad. (10) There is compelling evidence that acupuncture, physical therapy, massage, therapeutic touch, and distant healing work for physical complaints. If you answered true to any one of statements (1,3,4,8,10) or false to any one of statements (2,5,6,7,9), then you may benefit from this enlightening book authored by medical professor Dr. Nortin Hadler. Hadler explains the purpose of his book: "[This book] is written for all those well people who feel their sense of well-being is under attack...It is crafted to inform the reader who is well and how to feel well...[It] is a treatise on medicalization that is informed by science, clinical reality, and an analysis of life's morbid experiences-even episodes of disease...And I will explain how to avoid iatrogenicity-medical interventions that cause harm...Teaching the well how to approach the act of medical treatment critically is something of a heresy...Most of the lessons I will teach are heretical as well...This book is not for people who are already seriously ill." Below I will give the exact title of each chapter. For those titles that I feel are not descriptive enough, I will include some other material to give an understanding of what the chapter is about. (1) Interventional cardiology and kindred delusions. Topics covered include angina, cardiovascular surgery, interventional cardiology, and stroke. (2) Fats, fads, and fate. Discusses such things as body mass index, blood sugar, high blood pressure, and lifestyle changes. (3) You and your colon. Topics include colorectal cancer: its history, screening, and prevention. (4) Breast cancer and how the women's movement got it wrong. (5) (Male) prostate (gland) envy. Concentrates on the method used for screening for prostate cancer. (6) Musculoskeletal predicaments. Discusses such things as backache, knee pain, shoulder pain, neck pain, and the drugs used to treat these pains. (7) Medicalization of the "worried well." (8) Turning age into disease. (9) Health hazards of the hateful job. (10) Why are alternative and complementary therapies thriving? Throughout this book are statistical tables Hadler uses as evidence to back up the surprising (at least to me) comments he makes. Some people will say that Hadler only disc

It is obvious to anyone who follows the news or pays health insurance premiums that U.S. medical costs are spiraling out of control. This book, simply put, could save the system. Dr. Hadler makes it clear that some of the most expensive items in our national health care budget, like cardiovascular surgery, have little or even no real benefit. If we followed Dr. Hadler's recommendations and eliminated surgeries and treatments of minimal usefulness, health care expenses could probably be cut by 3/4. This book should be read by every concerned person. I especially enjoyed Hadler's analysis of musculoskeletal problems--backaches, shoulder and knee pain, and the like. I found it very refreshing to find out that such pains are a normal part of life for nearly everyone and that modern medicine really doesn't have anything more effective than aspirin to treat them. I also liked Hadler's discussion of the recommendation that we eat more fish, out of concern for our cardiac health. Being an environmentalist, I have always been puzzled by this recommendation. If everyone really ate the amount of fish recommended by cardiologists the fish stocks of the world would be depleted in short order. I was relieved to find that in fact the "eat fish" recommendation rests on exceedingly slim evidence. I work in the patent field myself, and in years past I was employed by a pharmaceutical firm. I can tell you from my own experience that drug companies have long since reached a point of diminishing returns in their research. Obviously everyone would like to feel better and live longer, but pouring more money into R & D for new, patentable drugs is not likely to improve our overall health very much. Dr. Hadler's work makes it clear that funding huge clinical studies of thousands of patients looking for tiny effects is a process very subject to error. In my opinion, we should be seriously considering shifting our approach to medicine away from high tech and more towards having someone there to hold your hand when you are sick. Our society would be better off for it. My major complaint about the book is that it is too short. Dr. Hadler chose only a few health problems to focus on. I would love to see his analysis of treatments for depression, allergies, and autism, among others. I also thought he left out important factors related to obesity, such as the design of cities and neighborhoods to make them walkable, and agricultural and other subsidies which make food artifically cheap.

This is an outstanding book that decries many components of traditional and alternative medicine. The book is not easy to read (Fog Index 16.9 corresponds to years of formal education; Flesh-Kincaid Index 13.8 corresponds to grade level). However, it is very informative to manage your own health in a more independent, cost-effective, and dignified way than otherwise. According to the author all our ills that truly result mainly from the natural process of aging have been "medicalized" at no benefit to the patient. But in turn, this medicalization has generated huge profits for the health care industries. The author has impressive credentials to advance his views. He is a professor of Medicine at one of the top U.S. public universities, and he is a practicing rheumatologist. Additionally, he has a strong background in statistics that he uses to interpret the objective results of random trials before spin doctors promote questionable benefit of whatever drug tested. Also, his "opinions' are well supported by 60 pages of references to random trials mentioned in the "Annoted Readings" section of the book. Human beings have a mean expected life span of 85 years. Advances in medical technology has done nothing to extend this life span. With aging, a bunch of proximate diseases (cardiovascular, cancers, and others) compete with each other to end our days. Thus, often the well publicized reduction in mortality for a certain type of cancer due to a treatment has no implication in extending one's life span for a single day. A survivor of prostate cancer may die at the exact same time he would have died of cancer but from cardiovascular disease. The author has analyzed many related random trials that confirmed this. "Medicalization" is in his view an artificial social construct whereby a condition (back or knee pain) has been turned into a disease. It results in Type II malpractice whereby patients that are well have incurred treatments (sometimes invasive and dangerous) that were not necessary. The benefit from breast and prostate cancer screening is highly questionable. Both mammography and the PSA tests generate so many false positive as to render the tests useless. The ensuing investigation, treatment, and surgeries from incurring a positive test are often painful, dangerous, and offer no proven benefits of any reduction in mortality rate. He feels just the same way about bypass surgery that provides no benefit and is associated with a high risk of death as a result of the operation (2% to 8%) or depression (50%). It helps only 3% of the coronary patient who do have extensive plaque blockage in their left-main artery. For the other 97% of patients, bypass surgery represents an unfavorable risk/benefit trade off. Alternative medicine is not spared either. He sees no benefit in most herbal, vitamins and mineral supplements. Chiropractic, homeopathy, and other alternatives do not seem more credible than traditi

When Nortin Hadler's book, "The Last Well Person," came my way, I realized my mother fit his titular profile to a tee. She lived to 84, just one year short of the ripe old age Hadler believes may be the fixed limit for our species. Her death from cancer, after a full life, did not bankrupt her spiritually or financially. Her body was not wasted by debilitating treatments capable only of keeping her alive a little longer-because she chose not to have any. Her decline began only shortly before her death. She benefited greatly from the palliative care she sought when she could no longer cope with the symptoms she was experiencing. (If you want to read her story, link to "Luck of the Dying" in the May-June 2005 issue of Health Affairs: http://content.healthaffairs.org/cgi/content/full/24/3/817?eaf). I practiced as a nurse for thirty-five years, twenty of them as a family nurse practitioner in a clinic providing primary health care to people of all ages and long term care to the elderly and dying in their homes. Close observation of my patients' experience with health care taught me that less is more when it comes to prescribing pills and procedures and that, especially for my elderly patients, supportive nursing care was, more often than not, the most effective treatment. Yes, there are sections in Hadler's book that may prove tough slogging for readers unfamiliar with medical terminology or statistical methods, but it's well worth the effort. I wish I could afford to put a copy into the hands of every one of the people I most care about.

I've waited quite a long time for this book to be published. The author is to be congratulated for his courage to show what`s really going on in the health care industry.A common error when it comes to the media is that they rely on press releases when reporting about scientific findings. This way information unfortunately gets distorted beyond recognition.Doctor Hadler did the right thing: he used the original data and conducted an independent analysis. This way the whole truth comes to light.You don`t have to be a statistician to understand the simple difference between relative and absolute risk reduction - that`s actually quite simple to explain. The question for you - the patient (or better yet the well person) is: is it worth it?And as the recent scandal over Vioxx showed the answer is (mostly) no.By the way: Doctor Hadler shows that the evidence that Vioxx is unsafe was available in 2000 already; a recent study in the Lancet came to the same conclusion.The author covers topics like breast cancer, colon cancer, muskuloskeletal disorders and many more. Illnesses that are literally worth billions of your dollars. If you want this to stop read this book and stay well; if you want to be medicalized to death - don`t read it.