Thu11272014

Your Health

Books untangle complex health-care questions

As the election looms, the debate over health care rages on. Questions about our right to health care, access, costs, fairness and quality fuel the fire.

The United States may be the world leader in health technology, but we also spend more on health care per capita ($7,146), and more on health care as a percentage of gross domestic product (15.2 percent), than any other nation (World Health Organization, 2008).

According to the Centers for Disease Control and Prevention, the U.S. also trails other wealthy nations in important measures, including infant mortality and life expectancy. And as many as 50 million Americans are without any kind of health insurance.

Health-care reform is clearly a controversial and highly complex subject. Opinions about how to fix our problems are not in short supply, but real solutions are hard to find. It behooves us to learn as much as we can about the topic, not only before we cast our votes in November, but also to know how best to advocate for the health of our families and ourselves.

Three provocative books that attempt to explain health-care system woes have similar names and premises: “Overdiagnosed: Making People Sick in the Pursuit of Health” (Beacon Press, 2011); “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” (Bloomsbury, 2007); and “Worried Sick: A Prescription for Health in an Overtreated America” (University of North Carolina Press, 2012).

“Overdiagnosed” protests the current system’s focus on disease rather than health. Author H. Gilbert Welch, M.D., a professor of medicine at Dartmouth Medical School, believes that our ability to detect abnormalities has become almost too good, that there are too many tests on people who have no symptoms, leading to too much treatment. People used to go to the doctor only when they were sick. Now we go for annual checkups, even when we are healthy. We just want to be sure that nothing is wrong.

Arguments can be made that early screening can prevent or aid control of many conditions, including cancer, diabetes and hypertension, and that advances in technology have saved many lives. Welch, however, believes that overdiagnosis is the “biggest problem caused by modern medicine,” adding “staggering costs to our already overburdened health care system.”

Whether you agree with the premise of this book or not, Welch provides a thought-provoking case, worthy of a reader’s consideration. He is able to make complex scientific concepts understandable and weaves them into well-told patient stories. Readers will learn how to make their own risk-benefit decisions to determine just how much health care is right for them.

“Overtreated” attempts to explain, from an economic viewpoint, how and why American medicine is out of control. Author Shannon Brownlee offers a simple premise: the health-care system in this country delivers a lot of care that we don’t need. In fact, she asserts that as much as one-third of the care people receive may actually be unnecessary.

Brownlee blames backward economic incentives in what she calls the “medical-industrial complex.” More spending, drugs and technology do not equal better care, according to Brownlee. Nor does increasing specialization, where it has become commonplace for a patient to have a number of physicians, none of whom talk to each other.

Brownlee, an economist and senior fellow at the New America Foundation, makes an argument for coordination of care among providers and for patients to advocate for themselves. As a culture, we have come to believe that we deserve, even need, more health care. Brownlee makes a convincing argument for careful, considerate, but limited care, with decisions based on knowledge and understanding of personal values.

In “Worried Sick,” author Nortin M. Hadler, M.D., presents a carefully reasoned case to help health-care providers assess the value and benefit of potential therapies to better treat their patients. He also calls for consumers to learn more about their own health so that they can differentiate between evidence and hype to make better decisions about their care.

Hadler clearly believes that there are many important medical developments, including diagnostic tests, drugs, surgeries and more, that can improve the quality of life and extend longevity for many people. He advocates judicious use of such services, believing that not everyone needs to become a patient.

Many of us are conditioned to view every unusual symptom we experience as a harbinger of an insidious disease. Hadler, a professor of medicine at the University of North Carolina, urges readers to relax and worry less about the disease lurking around the corner. His solution to health care is not in more care, but in better, more considered care for those who are truly sick and suffering.

All three books are available at Stanford Health Library, along with others that examine American health care and health-care reform.

Research help is free at Stanford Health Library. Phone, email or visit one of the library’s branches for evidence-based answers to health-related questions. Admission to the library, for 23 years a community service of Stanford Hospital, is free and open to the public.

The library is open in four locations: Stanford Shopping Center near Bloomingdale’s; the Stanford Cancer Center; Stanford Hospital (third-floor lobby); and the Ravenswood Family Health Center, 1807 Bay Road in East Palo Alto.

Nancy Dickenson is head librarian at Stanford Health Library. For more information, call 725-8400 or email This email address is being protected from spambots. You need JavaScript enabled to view it. .

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