Sunday, September 27, 2009

Overtreated, excess care

"Overtreated", "Overdiagnosed", and "Overdosed",... these are the terms I have used in one of seminars several years ago. By comparing the health care system between the United States and the China, you could easily think of these terms, especially when I heard the new medical conditions "ADHD - Attention-Deficit Hyperactivity Disorder", "M-IBS - Mixed Irritable Bowel Syndrome", "Chronic Fatigure Syndrome (CFS)", "fibromyhalia"; when I saw the images how many pills a patient took regularly.

Driven by the NPR interview with Shannon Brownlee (Are Today's Hospital Patients "Overtreated"?), I went to the local library to borrow her book "Overtreated: why to much medicine is making us sicker and poorer". I enjoyed very much in reading this book.

I intended to write a blog about this book, then found that many people had already expressed their opinion about this book. See Book Reviewer's comments from Amazon

Even though this book was written two years ago (in 2007), the arguments, the facts, the reasoning described in this book is very much relevant to the situation today (when the debate on the health care reform heats up). Below is a list of chapters:
  • One: Too Much Medicine
  • Two: The Most Dangerous Place
  • Three: Your Local Hospital
  • Four: Broken Hearts
  • Five: The Desperate Cure
  • Six: The Limits of Seeing
  • Seven: The Persuaders
  • Eight: Money, Drugs, and Lies (my favorite chapter)
  • Nine: The Doctor Isn't In
  • Ten: Less is More
Instead of going to detail, I would just cite some sentences from the book:
  • "Doctors have a saying: Never get admitted to a teaching hospital in July, because that's when all the new interns arrive fresh from medical schools."
  • "As research would show over the coming decades, stunningly little of what physicians do has ever been examined scientifically, and when many treatments and procedures have been put to the test, they have turned out to cause more harm than good."
  • "Every patient admitted to a hospital risks being hurt or even killed by the very people who wish to help her."
  • "Even as the number of [medical] imaging tests [X-ray, CT, MRI] is going up, numerous studies suggest that all those pictures are not nearly as effective at improving diagnosis as many doctors--and patients--tend to think."
  • "The drug company representative, or drug rep, usually [is] a handsome young man or shapely young woman who has been recruited more for his or her good looks and outgoing personality than for his or her aptitude for science or medicine."
  • "Among drug reps the unofficial name for thought leaders who work for multiple companies is 'drug whores'"
  • "The more specialists involved in your health, the more likely it is that you will suffer from a medical error, that you will be given care you don't need and be harmed by it."
  • "The Institute of Medicine estimates that only 4 percent of treatments and tests are backed up by strong scientific evidence; more than half have very weak evidence or none."
  • "In the view of Richard Horton, a British physician and editor of the prestigious medical journal the Lancet, 'Journals have devolved into information-laundering operations for the pharmaceutical industry'"
  • Says John abramson "The primary mission of medical research has been transformed. It used to be all about gathering information to improve health. Now clinical research is aimed at gathering information that will maximize return on investment"

Further readings:

1 comment:

koko said...

Just want to share my own experience. I am working at a local medical device company and one of our products is a software system to quantify the likelihood of chemo-induced febrile neutropenia for cancer pts receiving adjuvant chemo to help clinicians make decision whether or not give the pt G-CSF prophylaxis. It is amazing to find out from usability studies that how poorly the clinicians followed the guidelines and a validated personalized predictive model is soooo important to help them make the right clinical decision at the point of care.