Thursday, December 24, 2009


Why Too Much Medicine is Making Us Sicker and Poorer
Shannon Brownlee

Reviewed in Jandy's Reading Room

Did you really need that CT scan (or surgery or drug or treatment or...) your doctor recommended the last time you visited? Was the preventative testing you took really necessary or another way to possibly find out if something was wrong? Is your new designer drug for high blood pressure as effective as an older, cheaper drug?

Shannon Brownlee tackles the American healthcare system in this book, Overtreated Why Too Much Medicine Is Making Us Sicker and Poorer. She shows how and why American healthcare has changed since the 1970's and the age of Marcus Welby, M.D.

One thing I found fascinating is that medicine is a supply driven industry rather than a demand driven industry. For example, if you live in an area with a high percentage of cardiac cath labs you are more likely to get a cardiac cath for your heart problems than if you live in an area with less labs. You are just as sick either way, but are given different treatment because of the testing and procedures that are available. Depending on what drugs your doctor prefers, you may get a more expensive drug that doesn't work any better than another one. Sometimes the newer drugs are pushed only to later have the terrible side effects come to the public's notice (remember the Vioxx fiasco a couple years ago?).

I'm a medical librarian and have been involved in the medical field most of my career. As I read about the progression of the American health system since the 1960's when Medicare was first approved, and especially since the 1970's and 80's, I kept identifying with the changes. "I remember when that happened" or "DRG's were going to be death from the hospital's point of view" or "Yeah, MRI's were really expensive and the wonder diagnostic tools when they first came out." (Imaging tools continue to be invented that are bigger, better, and more expensive.)

Brownlee touts the need for medical practitioners to understand and use evidence-based medicine practices to treat patients. Doctors haven't been well trained to truly evaluate the good evidence-based journal articles, research papers, and other tools available to them. They aren't taught that type of critical thinking, which is different from diagnostics.

There is also a huge lack of primary care physicians available in this country. Specialists concentrate on their area of expertise. A patient may be treated differently with a vague chest or abdomen pain depending on whether the patients sees a cardiologist (heart doctor), gastrointestinal doctor (stomach and bowel system), surgeon, or endocrinologist (hormones, thyroid, diabetes, etc). A well trained primary care doctor (family practice or internist) who has the time to talk with a patient and good diagnostic training can hear all the symptoms and hone in on the true problem with the patient. A patient who skips the primary care doctor because the doctor is a "generalist" rather than the highly trained (and much more expensive) specialist may be treated for something that appears to be the problem but really isn't.

Of course politics are heavily involved in the American medical system. the American Medical Association carries a lot of weight with law makers. The drug companies lobbies are huge. The FDA is supposed to regulate drug releases, yet much of their funding comes in subtle ways from the large drug companies. There is no independent governing medical regulation agency that is free from Congress or the press of politics, although one could be established. The majority of medical clinical trials have funding from companies who have a stake in the findings. While that shouldn't influence the outcome of the studies, it will anyway.

These are some examples of Brownlee's arguments. She also offers a workable solution to help alleviate the problems. It would mean some major overhauls to most of our current practices, but there are pockets of groups and medical systems in this country that prove it can be done.

The book is easy to understand and read. Her tone is interesting and readable, not dry. Her topic is off putting and she'll take a lot of flak from different medical groups (I mentioned a couple above). Yet this book should be a call to overhaul the current system.

If you need medical care in the United States, I recommend this book so you know the state it's currently in.