Americans take from 25 to 50 percent more prescription drugs per capita than Canadians or Europeans, writes Brownlee.
(AP Photo/Mark Lennihan)
Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer
By Shannon Brownlee
Bloomsbury, 343 pp., $25.95
We didn't need Michael Moore to tell us that the American health-care system is broken; it's been front-page news for so long, we're getting - well - sick of hearing about it. Yes, Americans pay too much for care that is anything but caring, for technology that does little more than prolong our agony, for hospitals from which we emerge sicker than we entered. Our infant mortality rate ranks barely above that of a Third World country, and millions of children lack basic preventive care. One hundred thousand people die each year from vaguely categorized "medical errors." And most notoriously, the nation's growing legion of uninsured - more than 45 million and counting - must depend for their very survival on the increasingly unlikely kindness of strangers.
The disparity in our health-care system is a national disgrace: How is it possible that in the flushest nation on earth - a land where Botox injections are served up on demand for the rich - so many fail to get the basics?
Science writer Shannon Brownlee believes she has the answer. Americans, she reports, are getting not too little care, but too much. The American health-care system, she writes, rewards waste and penalizes efficiency. It is built not on evidence, but on the false claims of drug companies and the distortions of conflicted interests in the medical community. Her argument is compelling and at points persuasive, especially when it builds on original reporting and analysis. But in its overreliance on the journalistic bogeymen of anecdote and generalities, the book is not consistently convincing.
It is often said that medicine is as much art as science, but Brownlee would likely amend that adage by swapping "artifice" for "art." Medicine, she writes, has wrapped itself in the mantle of science, yet much of what doctors actually do is not scientifically justified. And because their compensation is largely determined by the number of procedures they perform, some doctors proceed with what Brownlee describes as reckless abandon, driven more by greed and arrogance than by concern for patients. To illustrate this point, Brownlee recounts a handful of well-documented cases of unabashed malpractice. While dramatic, these are familiar, and distract from Brownlee's more critical point: that the American health-care system overinvests in profitable treatments of questionable merit like spinal fusion and bone-marrow transplants, and foists them on an unwitting public in an effort to boost profits. By contrast, when health-care providers offer valuable care - teaching diabetics to control their blood sugar, for example, or making sure congestive heart failure patients take their medicine - they lose financial ground.
Like all of us, health-care providers are tempted to follow the money, and when it comes to medicine, it is the swashbuckling neurosurgeons, orthopedists, and cardiologists who cash in, not the kindly pediatricians and primary-care doctors. But that drug companies, insurers, hospitals, and - gasp - physicians sometimes act in their own interest rather than that of the patient is not news, and Brownlee squanders too much space rehashing horror stories - Vioxx, fen-phen - that have been well covered elsewhere. When she ventures onto less well-trodden ground, though, her insights are helpful. One such observation is that in America, medicine is supply- rather than demand-driven - treatments like heart stents and angioplasty are so common not because they prevent heart attacks (according to Brownlee they do not), but because they are profitable and covered by insurance. Her point that we overuse certain medical services simply because they are offered to us is a critically important one, as is her call for medicine to become more evidence-based.
Brownlee could have spent more effort on her final section, in which she poses solutions to the problems she sees. Her enthusiasm for Veterans Administration hospitals - which she lauds as the best hospitals in America - seems built almost entirely on evidence unearthed by journalist Phillip Longman, and made public in a magazine piece he wrote several years ago. While Longman did good work, Brownlee fails to probe deeper, and overlooks some fairly high-profile counter-examples, like the Dallas VA Medical Center, which just two years ago was cited as poorly managed, dirty, and dangerous. Of course a coordinated system of evidence-based medical care built around patient needs would be ideal; but designing that system, and creating a consensus to support it, is an enormously complex challenge, one that deserves far more serious discussion and consideration than Brownlee musters in this otherwise worthwhile and thought-provoking volume.
Ellen Ruppel Shell, co-director of the graduate program in science journalism at Boston University and author of "The Hungry Gene: The Science of Fat and the Future of Thin," is at work on a book about the science, economics, and societal impact of low price.
© Copyright 2007 Globe Newspaper Company.
