Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer

This book was also well-written. It is about medical treatment in the U.S. today, with attention to both providers and patients. It could have been much shorter, but the author gives the personal side of medicine and delves into many details. The approach leans to anecdotal. It tells how providers over-treat and over-prescribe because there are monetary incentives to do so -- from insurers, Medicare and Medicaid. It tells how patients, often armed with info obtained from the Internet, demand too much because they are insulated from the cost, often wanting more expensive and new but less effective treatments. The combination makes it a "supply-driven" market, in which what the providers have and know outweigh focus on the patient and the most effective treatment in the longer term. It tells about the frequent occurrence of errors with drugs and in hospitals. Treatment of patients tends to be uncoordinated by providers and there is a lack of use of patient-focused information technology. There is too much reliance on specialists and too little on primary care physicians. There is extensive coverage of the overuse of cardiac surgery and the era of high-dose chemotherapy with bone marrow transplant for women with breast cancer. The latter was a brutal process for the patient, with little improvement in outcomes, and very expensive. It covers spinal fusions. The reader will hear about how drugs are marketed and how and why they are prescribed. It covers the impact HMOs have had on medical practice. She compares the U.S. to other countries. Less is spent on medical care in other countries, but patients don't expect as much and have much less access to expensive and experimental treatment. I will point out one flaw. It's understandable the author makes it, since finance is not her expertise. Near the end she compares percent return on sales of Pfizer, General Electric and Wal-Mart. This implies Pfizer is many more times profitable than Wal-Mart. It is very misleading because these are much different types of business, with far different rates of inventory turnover and research and development costs. A much better comparison is return on equity. For the latest five years on this basis Wal-Mart was 1.7 times as profitable as Pfizer.

XXXXX "[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 H

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

Yes, some of the information in the book can be found in other books, but not everyone has the time to read dozens of different books on the subject or american medical care both pros and cons. Who ever knew that a town in Oregon was #1 in the number of back surgeries or a place in the midwest was # 1 in cardio procedures. Medicine has sure made itself into special places for certain medical procedures. And her information on how medical procedures and doctors connections to medical providers be it equipment or insurance coverage is equally interesting. Already knew Sweden was great when it came to medical care, as well as France in many ways. Sweden is it should be noted is a country with a non minority cultural connection that combines food choices and lifestyle choices that most of the citizens identify with. When everyone in a country with a common goal cooperates the results are an overall high standard of living for everyone. Would have liked to have had the author actually spend time in France and Sweden looking firsthand at how things are done, rather than rely on other peoples information or antidotal examples.

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.