Volume 189 - Issue 5
What ails America
Author: Melissa Sweet
Med J Aust 2008; 189 (5): 273. || doi: 10.5694/j.1326-5377.2008.tb02025.x
Published online: 1 September 2008
Published online: 1 September 2008
Worried sick: a prescription for health in an overtreated America.
Nortin M Hadler. Chapel Hill: University of North Carolina Press, 2008 (viii + 376 pp). ISBN 978 0 8078 3187 8.
Public and professional debate about health services has traditionally been dominated by concerns that needy patients are missing out on helpful care. In recent years, another perspective has been gaining ground: that too many people are having unnecessary, ineffective or even harmful tests and treatments.
This argument is strongly and provocatively put by Nortin Hadler, Professor of Medicine and Microbiology/Immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals, in his second book examining this issue.
Professor Hadler argues that the institution of medicine has become self-serving in its medicalisation of the everyday complaints of life. He describes as “type II medical malpractice” doctors doing the unnecessary, albeit very well, and argues that health insurance should only underwrite interventions with a meaningfully advantageous benefit-to-risk ratio.
His critique of the evidence used to back many common interventions is scathing, and he gives particularly short shrift to the claims of interventional cardiologists and cardiac surgeons. Others in his sights include the New England Journal of Medicine’s Editor-in-Chief, Dr Jeffrey Drazen, and epidemiologists involved in such practices as data dredging.
Professor Hadler has little respect for holy cows, finding faults with evidence-based medicine, systematic reviews, large randomised controlled trials, and the quality movement.
But he is not a nihilist. He wants to bolster people’s resources for coping with the everyday complaints of life, whether they be heartburn, backache, or insomnia. To be well, he points out, is not the same as feeling well.
Readers may disagree with Professor Hadler’s interpretation of the literature or philosophical view. But don’t let this put you off. Apart from providing plenty of food for thought, his self-confessed “diatribe against medicalisation” is an engaging read.
“We are”, he rails at one point, “a country of obese, hypercholesterolemic, hypertensive, diabetic, osteopenic, depressed, pitiful creatures perched on the edge of a cliff staring at condors: cancer, heart attacks, strokes, dementia, fractures and worse. We fear for our future. We teach our children that they, too, must live in fear for their future.”