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Is a CT scan always necessary after your child suffers a bump on the head? Should you think twice before undergoing surgery for lower back pain? Are your elderly parents going to be allowed to die at home, or will they spend their last few weeks in a hospital, hooked up to machines and tubes, subjected to painful, unnecessary procedures?
These are the kinds of questions you may find yourself asking once you’ve read Overtreated. Each year, our medical system delivers an enormous amount of care that does nothing to improve our health or lengthen our lives. Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be. This is the surprising and deeply counterintuitive message of Overtreated.
Of course, almost everything in our personal experience says just the opposite, that far from delivering too much care, our medical system isn’t giving us enough. Forty-seven million of us don’t have coverage, and even those of us who do have health insurance feel as if our insurers and doctors are continually trying to deny us treatments and tests and drugs that could help us.
Yet as award–winning journalist Shannon Brownlee shows in this remarkable book, much of what we think we know about health care is simply wrong. With probing insight and facinating examples, Brownlee unveils its topsy-turvy economics, where the supply of medical resources—beds, specialists, intensive care units—determines what care we receive, rather than how sick we are and what we actually need.
Overtreated offers a fresh way to think about health care reform. Americans worry about rationing—that any effort to rein in costs will lead to restrictions on treatments that could improve our health. But as Brownlee argues in this compassionate and compelling book, we can improve the quality of American medicine, control costs, and cover the uninsured—all without the limitations and expense that Americans fear. Her humane, intelligent, and penetrating analysis empowers readers to avoid the perils of overtreatment in their own care, while simultaneously pointing the way to a better system.
Selected reviews are featured below. To learn more about this book, please go to overtreated.com.
The New York Times
Wednesday, Dec. 19, 2007
...Overtreated, by Shannon Brownlee... is my choice for the economics book of the year. This was another very good year for economics books. Alan Greenspan wrote a best-selling memoir that was really two books, one an autobiography, the other an exposition on the virtues of the free market. Robert H. Frank and Robert Reich wrote thoughtful books about reversing the excesses of that free market. Paul Collier offered a clearheaded argument for reducing global poverty in The Bottom Billion.
But I’m going with Ms. Brownlee’s book because it’s the best description I have yet read of a huge economic problem that we know how to solve -- but is so often misunderstood. ...
The typical book about current affairs is better at describing problems than solutions. But there is a nice surprise at the end of “Overtreated.” (If you find yourself wishing the book had fewer anecdotes, I’d suggest you skip to the end rather than putting it down.) In plain English, Ms. Brownlee lays out an agenda for reform that is usually confined to academic journals.
It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.
Other solutions would be more difficult -- because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it’s the other guy who’s getting unnecessary treatment. These are the reasons that presidential candidates don’t focus on wasteful treatment.
But models for reform are out there. Hospitals that don’t use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance -- that is, the health of their patients -- and motivate employees to improve it.
As I’ve written before, there is nothing wrong with devoting a large chunk of our economy to medical care. Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century.
If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century. -- David Leonhardt
The Cleveland Plain Dealer
Sunday, Sept. 16, 2007
As a primary care physician, I often feel like the voter drawing laughs from economists at cocktail parties - you know the one who keeps showing up at the polling booth out of some irrational conviction that a single vote might actually affect the outcome of a process controlled by much larger forces.
Picking up Shannon Brownlee's "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer" certainly didn't help. It's unpleasant, discouraging and confirms that sinking feeling we all recognize -- that the more technologically advanced and specialized our health-care system becomes, the worse we feel.
"Overtreated" is a necessary, if bitter, tonic. As the election season starts to take shape, we desperately need an unbiased examination of the mess we're in and some substantive ideas for fixing it. "Overtreated" delivers on both counts.
Brownlee, a well-respected medical journalist, uncovers some truly amazing facts. It turns out the likelihood of you being admitted to an ICU or having your gall bladder removed depends more upon where you live than how sick you are. This is partly because there is no proven "right" way of managing most medical conditions, so doctors tend to absorb the habits of the area where they train and practice.
But like most human endeavors, the real driving force is economics. Thanks to the historical accidents that led to our employer-based health insurance system, medicine follows a course counterintuitive to the rules of supply and demand. If there were as many grocery store chains as neurosurgeons in Cleveland, the chains would be forced to lower prices, improve services or close. But because the people who "buy" health-care services -- you and your doctor -- don't directly pay the bill, the demand tends to rise with supply.
Meticulously, Brownlee details how almost everyone along this malfunctioning grid is vested in keeping it running. Drug companies manipulate the media and the medical literature to convince us that every twinge is an illness that requires an expensive pill. Insurance companies reimburse physicians for doing procedures, so medical students with six-figure student loans flock to radiology while family-practice residencies close down. Hospitals wage an unremitting arms race for the newest gadgets to attract superspecialists who generate the revenue that offsets money-losing pits like emergency rooms and obstetric clinics.
At times, Brownlee has a tendency to throw the baby out with the bath water. Showcasing a rare, but horrendous outcome from a college student taking an anti-depressant ignores the tens of thousands of people who couldn't function without them. But overall she maintains an even keel, which allows her to find some intriguing solutions in unlikely places.
While Walter Reed medical center recently received a black eye for its woeful treatment of patients, Brownlee reports that the Veterans Administration "outpaces most of the rest of American health care on nearly every measure of quality." By employing more primary-care docs and fewer specialists, coordinating electronic medical records and implementing a capitation system in which physicians are reimbursed for how well they manage the health of a group of patients rather than for how many things they do to individual ones, the old dinosaur of government health care is apparently full of happier doctors and healthier patients.
So let those economists laugh. Sure, the odds are long when the goal is shifting the political, cultural and economic forces, but Brownlee has given us a thoughtful push in the right direction. --John Vaughn
Additional Praise for Overtreated
"This book could save your life. In gripping detail, Shannon Brownlee explains how well-insured Americans get much more high-tech medical care -- CT scans, angiograms, and the like -- than they need, enriching the hospitals and doctors who provide it, but driving up the overall costs of health care and often endangering patients' lives. Brownlee clearly shows in this important book that overtreatment, like undertreatment, is very bad medicine."
-- Marcia Angell, M.D., former editor-in-chief of the New England Journal of Medicine and author of The Truth About the Drug Companies
"In the blizzard of books on our healthcare system, Shannon Brownlee's is unique in its provocative argument that individuals and nation suffer from misguided and costly treatments. Patients, physicians, and policy makers would do well to consider her evidence as an important prescription for reform."
--Jerome Groopman, M.D., Harvard Medical School and author of How Doctors Think
Readers who have thrown out recalled, expensive prescription drugs, grieved at the death of a friend who died from a "minor" surgical procedure, or agonized over the hospital care experienced by their dying, elderly parents will experience the shock of recognition in Overtreated. Science journalist Brownlee (Atlantic Monthly, NewRepublic) has mined medical journals, reports from authoritative health care organizations, and troubling personal narratives by doctors and patients to present a stunning but reasoned picture of the out-of-control, inefficient, and often tragically ineffective U.S. health care system. Compared with those who live in other First World countries, Americans see more specialists, receive more days of hospital care, and undergo far more diagnostic procedures. Paradoxically, the result of this surfeit is frequently a less favorable—if not fatal—medical outcome. Stories of the perverse economic incentives for Medicare and private health insurers, poor oversight on the part of the Food and Drug Administration, and common medical procedures based on no more scientific evidence than bloodletting are interwoven in a compelling call for patient-centered, evidence-based health care—admittedly, not a modest proposal. More optimistically, Brownlee points to institutions that already use these measures, including, surprisingly, the Veterans Health Administration. This rousing call for change, accessible to general readers, is recommended for all libraries.
--Kathy Arsenault, Univ. of South Florida at St. Petersburg Library, LJXpress
"With her razor-sharp analyses, Brownlee disentangles the aradoxes of today's health care mess and turns every assumption on its head. She will forever change the way you view health care while re storing your hope for its future. This book is an important read for anyone interested in health care reform, which, in this day and age of overtreatment, should be all of us."
-- Pauline Chen, M.D., author of Final Exam: A Surgeon's Reflections on Mortality
"Overtreated will scare you. And that's a good thing. In this vivid and arresting tour of medicine in America, Shannon Brownlee shows why the care that is supposed to make us healthier frequently makes us sicker instead. At a time when health care reform is atop the political agenda again, this book should be required reading -- not only for every lawmaker and medical professional, but for every voter and patient, too."
-- Jonathan Cohn, author of Sick: The Untold Story of America's Health Crisis
"Finally, someone willing to expose the dirty little secret of U.S. health care. If you have insurance you will certainly get too much health care, and when it comes to medicine more is definitely not better! Overtreated will open your eyes to the problems and point the way to the answers."-- Susan Love, M.D., author of Dr. Susan Love's Breast Book and President and Medical Director, Dr. Susan Love Research Foundation