New books show that the need to improve health care grows only greater
THE TREATMENT TRAP
How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It
By Rosemary Gibson
and Janardan Prad Singh
Ivan R. Dee, 237 pages, $24.95
Amid all the cheering and jeering over the health-reform legislation recently signed into law, there remains one sober fact about our medical system that every American ignores at his or her peril: Contact with the health-care system remains one of the leading causes of death in the United States. The most recent confirmation comes from a new study from the independent ratings company Health Grades, which found that between 2006 and 2008, nearly 100,000 Medicare patients died due to medical errors.
With tens of millions of currently uninsured Americans now promised greater access to care, the urgency of reforming the practice of medicine, as opposed to its financing, has never been greater. This makes the two books reviewed here particularly relevant, whether you are an individual trying to navigate though the increasingly dangerous and dysfunctional health-care delivery system or a policymaker trying to figure out what's gone wrong and how to fix it.
"The Treatment Trap" is co-authored by Rosemary Gibson, who long worked at the Robert Wood Johnson Foundation on health-care quality and safety issues, and by Janardan Prad Singh, an economist at the World Bank whose previous work has concentrated on the same area. Together, they have produced a well-told, well-researched catalog of horrors about people killed and maimed by tests and operations they didn't need.
Theirs is not the first popular account of the dangers of over-treatment, but it updates a story that cannot be told often enough, and in a way that can serve as a useful consumer guide to anyone contemplating a course of treatment. Good to know, for example, that one-third of all heart bypass surgeries are unnecessary or that there is virtually no evidence to support surgery for back pain. The authors are particularly effective in pointing out that much going on in the name of prevention and diagnosis is wasteful or harmful. For example, they cite a study that found that undergoing a full-body CT scan exposes a patient to a dose of radiation comparable to that experienced by some of the survivors of Hiroshima, yet has little proven value. Millions of women who have undergone hysterectomies (a vastly overused procedure itself) are given Pap smears to test for cervical cancer, even though they no longer have a cervix.
Reading "The Treatment Trap" will set you up well for the subject of Thomas Goetz's "The Decision Tree": how to use a health-care system in which it is impossible to know whom to trust. Goetz is a longtime editor at Wired magazine, which means he knows how to write and has a deep regard for the Internet and other information technologies. And he holds a master's in public health from the University of California at Berkeley, which means he's on top of the mountain of new research showing the great disparities in how doctors in different parts of the country treat the same diseases.
These different facets of his background come together in a specific idea of 21st-century medicine. In this vision, patients use comparatively low-tech devices such as smartphones to collect data about themselves, such as blood pressure, glucose levels, how many steps they walk in a day, etc. They use those data as a psychological spur to adopting more-healthful lifestyles and better management of any chronic conditions they might have. And, more radically, they share much of this information on Web sites such as Patientslikeme.com, where people dealing with similar health issues can compare outcomes while creating a database that researchers can use to figure out what works and what doesn't in health care.
Goetz foresees a world in which individuals are much more attuned to the power of social networks to help them with their health problems and to process large flows of medical data in ways that advance science. It's a vision that will probably alarm many older Americans concerned with medical privacy and paranoid about any potential breach. But for members of the Facebook generation, it's likely to make perfect intuitive sense.
The secrets we keep in health care, whether it's the results of drug company tests that failed or all the data contained in lost and scattered paper medical records, come at a great cost to medical progress.
Longman is the author of "Best Care Anywhere: Why VA Healthcare Is Better Than Yours."