- © 2008 Canadian Medical Association
Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee, Bloomsbury USA; 2007; 343 pp $28.95 ISBN 978-1-58234-580-2
Six billion people on this planet inhabit a world of unimaginable health extremes. At one end of the spectrum, 28 000 children under 5 die every day from poverty and easily preventable diseases, such as diarrhea, tuberculosis and malaria. At the opposite end of the spectrum, a billion of us expend enormous wealth in the pursuit of diseases long before they pose any real problem, guided by a most powerful belief that prophylactic medicine — medicine that often works against the dictates of evidence, rationality or even common sense — presents nothing but positive contributions to our health.
It's at this extreme end of the spectrum that Shannon Brownlee's new book, Overtreated, focuses its analysis. She examines the US health care system but the stories seem very familiar, perhaps because Canadians too are affected by those forces that give rise to exploding health care costs: perverse incentives, misinformation about the value of many health procedures and an insidious profit motive that sometimes results in the delivery of health care that is a waste, unnecessary and even harmful. She surveys a whole range of expensive and sometimes useless health care practices, from bypass surgery (half of bypass surgery patients over 65 suffer some from of dementia as a result of their surgery) to cancer screening, where much of the screening and scanning for disease causes immeasurable anxiety in the population, yet delivers little demonstrable health benefit.
Brownlee, a crack American health journalist, who has written for The Atlantic Monthly and The New York Times Magazine, has produced a compelling and damning indictment of the way health care is organized and delivered in the richest country in the world. If Michael Moore's recent film Sicko exposed viewers to the excruciating dilemmas faced by people who can't access ingenious American medicine (CMAJ 2007;177: 379-80), Overtreated provides us the flip side, with compelling stories of people who are injured or die because they get too much of a good thing.
Readers will find some territory in this book previously covered by others. Her chapter on the pharmaceutical industry (“Money, Drugs and Lies”) covers similar ground as Jerry Avorn's excellent Powerful Medicine and Marcia Angell's The Truth About the Drug Companies. The overabundance of unnecessary care has been tackled by Norman Temple and Andrew Thompson's Excessive Medical Spending and Arndt Von Hippel's Better Health Care At Half The Cost.
Nevertheless, Canadian health policy-makers could learn a lot from this book. If anything it could help them become better advocates for research and practices that can protect patients from the enthusiastic excesses of a medical system that embraces an unthinking “more-is-better” philosophy. Canadian physicians too will find a lot to ponder in this book, because, whether it's a role they like or not, they are the gatekeepers to our health care and most decisions on who passes through those gates are determined by the collective and individual actions of our physicians.
Footnotes
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Alan Cassels is a drug policy researcher at the University of Victoria, Victoria, British Columbia. His latest book is The ABC's of Disease Mongering, a Guide to Drugs and Disorders.