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

Fall 2010 CSANews Issue 76  |  Posted date : Sep 17, 2010.Back to list

Overtreated is an important book. It's even been described as a "bombshell of a book." In it, award-winning journalist Shannon Brownlee dissects the American health-care system to discover, "Why Too Much Medicine is Making Us Sicker and Poorer."

This is an American book. The Canadian Medical Association labels it "a compelling and damning indictment of the way health care is delivered in the richest country in the world." We've all heard rants about the 47 million Americans who are uninsured, but Brownlee has dramatic tales of insured people who are injured or die because they get too much of a good thing - too many CT scans, angiograms and the like, that make us sicker, rather than healthier. Tens of thousands of patients die each year from overtreatment.

Though the statistics are American, the medical-care issues are universal. In Canada as in the United States, there are too few general practitioners. Brownlee suggests that in the future, we need to find a way to finance medical education in a way that will promote primary care. We have too many specialists because medical students graduate with so much debt that they feel compelled to make more money.

Brownlee tells a folksy story about a Dr. Jack Wennburg who, 40 years ago, saw a variation in practice patterns in the state of Vermont. It's not driven by how sick patients are, but by where the specialists are. Studies through the years have proven Wennburg's theory. Today, for example, it's a known fact that if you move from Tampa to Fort Myers, Florida, your chances of getting back surgery go up by 60%.

Two factors sending the costs of health care sky-rocketing are drugs and imaging. Thirty years ago in the U.S., the vast majority of scientific studies involving human subjects was funded by the federal government. Today, the pharmaceutical industry underwrites at least 80% of this clinical research. This has led to some conflict of interest reporting in medical journals and the promotion of some dangerous products. Brownlee names names and gives some scary examples. An FDA safety expert, for example, estimates that as many as 60,000 Americans died from taking the painkiller Vioxx. It doubled the risk of heart attack and stroke, but was no more effective than over-the-counter Ibuprofen.

Costs for imagery are going up faster than costs for drugs. Radiology is quite profitable. It can be the profit centre for a hospital, so don't ask for a CT for a sprained ankle.

In this book, Brownlee takes us through the mechanics of running a hospital, the drama of heart surgery and stenting, and the overuse of the latest technological devices. Her bottom line advice is to have a long-standing relationship with a primary-care physician who keeps electronic medical records.

She also recommends that we each have an "end of life strategy" (perhaps a living will), because "dying is not an option." Brownlee muses that as we really get old, and really get sick in a lot of ways, what we need is someone to hold our hands and manage our care. Who wants to end their days in ICU with machines hooked up to every orifice, tormented by unnecessary expensive procedures?

Read Overtreated and make informed choices!