By Shannon Brownlee
Bloomsbury USA, 2007; $29.95
Reviewed by Jill Chapin
Shannon Brownlee’s Overtreated would agitate you if it were fiction; that it is fact will upend everything you’ve come to understand about our medical care. Written with no hyperbole, it will be difficult to dismiss this book as inflammatory, as the facts speak for themselves.
Overtreated is laced with exhaustive, well-researched studies that give credibility to the true anecdotal stories peppered throughout the book. What you will discover will be quite alien to what we have been led to believe.
You will get the sense that we’ve all been had, that we have been seduced by all those high-tech testing devices and medical procedures and designer drugs made so readily available to us. You will come to understand that more is not better. Yet in all of the discussions about health care reform, have you ever heard overtreatment being discussed? If you currently associate less treatment with rationing, you won’t after you read this book.
It is difficult to accept the concept of being overtreated. Haven’t we all believed that the most serious problem with our health care is that many are not getting enough? Yet extensive studies done all over the country have proven that in areas and hospitals where more drugs and procedures and tests were performed, patients did no better than in places where less was offered. And sometimes they fared worse.
The more medical procedures offered, the greater the chance for medical error. And increased drug consumption is not so much for saving lives or curing serious conditions as it is for helping us cope with ordinary existence. Except when they don’t and we’re harmed by them. The odds simply increase that someone will make a mistake with procedures and prescriptions, and it is these odds that account for about 30,000 deaths each year from unnecessary care.
Research has shown that high rates of surgery in certain parts of the country were not driven by patient need but by the doctors who perform them. Doctors who send patients for procedures or tests when they have a financial stake tend to order more than doctors who don’t have a financial incentive.
Hospitals will first set up imaging centers or cancer clinics and then hire doctors who will be richly compensated for bringing patients to them. This upside-down version of supply and demand is unique to the world of medicine, where supply dictates demand. Cars and computers are built according to demand because an overstocked warehouse would necessitate a price reduction. This is not the case in medicine. Hospitals will simply recruit more doctors to send more patients. With a simple change in the definition of disease, healthy people can be instantly transformed into patients receiving all of the overtreatment that being labeled sick entails.
Radiation, for example, is profitable. Some radiologists are concerned that the excessive amounts of radiation that some people are getting is contributing to the skyrocketing rates of thyroid cancer.Yet contrary to popular belief, imaging devices simply are not as accurate as we have been led to believe. This is corroborated in autopsies showing that rates of misdiagnosis have remained virtually unchanged since the turn of the last century.
The vast majority of invasive cardiology procedures aren’t life-saving, they are elective. Worse, according to cardiologists’ own rules, at least 160,000 annual stents or angioplasties should not have been done. Spinal fusion and arterial stents have actually been proven in many studies to either do no good or to do actual harm. But because American medicine values innovation and profit at the expense of caution, we the patients pay the price with both our wallets and our health.
As you will come to realize after reading Overtreated, less really is more when it comes to optimum health care. And if we had better information, we would likely reject some of those treatments and tests and drugs. Therefore, we would be wise to question our doctors more often. Keep in mind what many deans tell their medical school graduates: “Half of what you learned is wrong. But we don’t know which half.”
Reading Overtreated is the easiest, most comprehensive route to becoming more informed about our health care options in order to better the odds.