Saturday, April 25, 2009

95 (2009 #20). Overtreated

by Shannon Brownlee

Subtitled, "Why Too Much Medicine is Making Us Sicker and Poorer," I read this book on the recommendation of a friend who is a librarian and has a medical background as well. My husband's right carotid artery is 70% blocked, and the doctors (internist, cardiologist, and vascular surgeon) all recommend an endarterectomy. However, the surgery is not without risks, and 70% falls right in that borderline area where, if asymptomatic (for strokes and TIAs), you could go either way. This book specifically mentions this procedure (on pages 204-205), which was why she suggested I read it.

It's an eye-opener. Author Shannon Brownlee has a master's degree in biology and writes on medical and health care topics. On page 9, Brownlee says her book "is an exploration of three simple questions. What drives unnecessary health care? Why should we worry about it? And once we understand how pervasive it is in American medicine, how can we use that knowledge to create a better system?"

Brownlee shows how doctors, hospitals, and drug and device manufacturers are rewarded (mostly by health insurance systems) for how much care they deliver rather than how effective it is. Coupled with most Americans' tendency to want SOME kind of treatment when they go to a doctor, either medication or tests, even when unneeded, Brownlee shows how costs are driven up while quality of care usually does not improve.

Brownlee uses numerous (often scary) examples throughout the book to illustrate her points, and concludes with a chapter that recommends some changes in current health care practices - but not socialized medicine. She gives the Veterans Administration hospitals as an example of a system to model - which surprised me, simply because I did not know they were that good. She also recommends electronic medical records, something that I am surprised is so slow to be adopted in the medical field.

The book is easy to read and understand - EXCEPT for the horrible end notes! She doesn't use standard footnotes, nor any numbering at all in her end notes, and it is difficult to find the sources for some of her statements. And some of those you can find don't make sense. For example, when she states on page 204 that "vascular surgeons performed about eighty-eight thousand unnecessary carotid endarterectomies in 2002, thereby causing an unknown number of strokes," the end note references personal communication with a British neurologist, and a published study that compares the outcomes of endarterectomies with another procedure, stenting. It's not at all clear what, if anything, supports her 88,000 figure - and that, in my opinion, is the biggest weakness of this book. I would certainly recommend reading it, but keep this weakness in mind.

1 comment:

  1. I heard a recent report on NPR about how McAllen, TX spends more per person on Medicare than almost anywhere in the country.Link

    ReplyDelete