Health Care and Medicine

Klitzman CoverAm I My Genes? Confronting Fate and Family Secrets in the Age of Genetic Testing by Robert Klitzman (Oxford University Press, 2012).

In the fifty years since DNA was discovered, we have seen extraordinary advances. Genetic testing has rapidly changed the diagnosis and treatment of diseases such as Huntington’s, cystic fibrosis, breast cancer, and Alzheimer’s. But with this knowledge comes difficult decisions for people who wrestle with fear about whether to get tested, and if so, what to do with the results. Robert Klitzman interviewed 64 people who faced Huntington’s Disease, breast and ovarian cancer, or Alpha-1 antitrypsin deficiency. The book describes–often in the person’s own words–how each has wrestled with the implications genetics has for their lives and their families – from issues of identity and fate, to those of reproductive choices. Read a Breast Cancer Consortium Review»

How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley (St. Martin’s Press, 2012).

Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with an impressive clinical, research, and policy career. This book pulls back the curtain on how medicine is practiced in America. Brawley tells of doctors who select treatment based on payments they will receive rather than demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (as long as insurance will pay); a public primed to swallow the latest pill no matter the cost; and rising healthcare costs for unnecessary— often unproven—treatments. Brawley calls for rational healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs. Read an Interview with Otis Webb Brawley»

The Cost of Pushing Pills (Essay) by Marc-André Gagnon and Joel Lexchin (PLOS Medicine (2008).

IMS, a firm specializing in pharmaceutical market intelligence, is usually considered to be the authority for assessing pharmaceutical promotion expenditures. The US General Accounting Office, for example, refers to IMS numbers in concluding that “pharmaceutical companies spend more on research and development initiatives than on all drug promotional activities.” Based on the data provided by IMS, the Pharmaceutical Research and Manufacturers of America (PhRMA), an American industrial lobby group for research-based pharmaceutical companies, also contends that pharmaceutical firms spend more on research and development (R&D) than on marketing: US$29.6 billion on R&D in 2004 in the US as compared to US$27.7 billion for all promotional activities. In this paper, we make the case for the need for a new estimate of promotional expenditures. We then explain how we used proprietary databases to construct a revised estimate and finally, we compare our results with those from other data sources to argue in favor of changing the priorities of the industry.  It appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry’s claim.

Overdiagnosed: Making People Sick in the Pursuit of Health by H. G. Welch, L. Schwartz, and S. Woloshin (Beacon Press, 2011).

Drawing on 25 years of medical practice and research, Dr. H. Gilbert Welch and colleagues, Dr. Lisa M. Schwartz and Dr. Steven Woloshin, have studied the effects of screenings and presumed preventive measures for disease and “pre-disease.” Welch argues that while many Americans believe that more diagnosis is always better, the medical, social, and economic ramifications of unnecessary diagnoses are seriously detrimental. Unnecessary surgeries, medication side effects, debilitating anxiety, and the overwhelming price tag on health care are only a few of the potential harms of overdiagnosis. According to Welch, a complex web of factors has created the phenomenon of overdiagnosis: the popular media promotes fear of disease and perpetuates the myth that early, aggressive treatment is always best; in an attempt to avoid lawsuits, doctors have begun to leave no test undone, no abnormality-no matter how incidental-overlooked; and, inevitably, profits are made from screenings, a wide array of medical procedures, and pharmaceuticals. Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.

Over-diagnosis Epidemic,“A Nine-Part Series of articles in The Conversation, 2012.

Contributors: Ray Moynihan, Senior Research Fellow at Bond University; Robin Bell, Professor and Deputy Director, Women’s Health Program, School of Public Health and Preventive Medicine at Monash University; Robert Burton, Professor in the School of Public Health and Preventive Medicine at Monash University; David Le Couteur, Professor of Medicine at University of Sydney; Jacqueline Savard, PhD Candidate at University of Sydney; Christopher Stevenson, Professor of Epidemiology at Deakin University; Mark Frydenberg, Head of Urology at Monash Medical Centre and Associate Professor of Surgery at Monash University; Jenny Doust, Professor of Clinical Epidemiology at Bond University; Rae Thomas, Research Fellow at Bond University; Stacy M. Carter, NHMRC Career Development Fellow at University of Sydney; Pul Glasziou, Professor of Medicne at Bond University.

Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer by Shannon Brownlee (Bloomsbury, 2007).

Medical journalist Brownlee acknowledges that state-of-the-art medicine can improve care and save lives. But technology and drugs are also misused and overused as billions per year are spent on unnecessary tests and drugs and on specialists who are rewarded more for recommending certain procedures over other more appropriate ones. Overtreated shows how our health care system delivers unnecessary care that is not only wasteful but can actually imperil the health of patients. It also shows that there are hospitals and health care systems that have found ways to rein in waste, cut down on errors, and provide inspired and inspiring medicine that is based on sound evidence. Brownlee’s humane, intelligent, and penetrating analysis empowers readers to avoid the perils of overtreatment, as it points the way to better health care for everyone.

Seeking Sickness: Medical Screening and the Misguided Hunt for Disease by Alan Cassels (D&M Publishing, 2012).

Why wouldn’t you want to be screened to see if you’re at risk for cancer, heart disease, or another potentially lethal condition? After all, better safe than sorry. Right? Not so fast, says Alan Cassels. His Seeking Sickness takes us inside the world of medical screening, where well-meaning practitioners and a profit-motivated industry offer to save our lives by exploiting our fears. He writes that promoters of screening overpromise on its benefits and downplay its harms, which can range from the merely annoying to the life threatening. If you’re facing a screening test for breast or prostate cancer, high cholesterol, or low testosterone, someone is about to turn you into a patient. You need to ask yourself one simple question: Am I ready for all the things that could go wrong?

Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients by R. Moynihan and A. Cassels (Nation Books, 2006).

Thirty years ago the head one of the world’s largest drug companies (Merck), told Fortune magazine he wanted his company to be more like chewing gum maker Wrigley’s so it could make drugs for healthy people and sell them to everyone. That dream now drives the marketing machinery of the most profitable industry in the world. Drug companies work to widen the definitions of illness to make markets for medications larger. Mild problems are redefined as serious illnesses and common complaints labeled as medical conditions in need of drugs. Selling Sickness reveals how widening the boundaries of illness and lowering the threshold for treatments creates millions of new patients and billions in new profits, threatening to bankrupt health-care systems worldwide.

Should I Be Tested For Cancer?: Maybe Not and Here’s Why by H. Gilbert Welch (University of California Press, 2006).

Getting tested to detect cancer early is one of the best ways to stay healthy—or is it? A recognized expert challenges the widely accepted belief that the best defense against cancer is to always try to catch it early. Dr. H. Gilbert Welch shows that testing healthy people for cancer is a double-edged sword: while tests may help, they often have surprisingly little effect and are sometimes harmful. Bringing together a body of  research in an engaging and accessible way, Welch discusses the pitfalls of screening, showing how they miss some cancers, lead to invasive, unnecessary treatments, and distract doctors from other important issues. A comprehensive overview of challenges in screening, the limits of current technology, and the technological imperative to oversell screening to the public and health practitioners.

Testing Treatments: Better Research for Better Healthcare by Imogen Evans, Hazel Thornton, Iain Chalmers, Paul Glasziou (2006, 2011).

Testing Treatments urges everyone to get involved in improving current research and future treatment, and outlines practical steps patients and doctors can take together. The authors focus on how to ensure that research is soundly based, properly done, able to distinguish harmful from helpful treatments, and designed to answer questions that matter to patients, the public, and health professionals. The second edition includes a thought-provoking chapter on screening, explaining why “early” diagnosis is not always better. Other new chapters explore how over-regulation of research can work against the best interests of patients and how robust research can be used to shape the practice of healthcare in ways that allow treatment decisions to be reached jointly by patients and clinicians. 

The Politics of Cancer Revisited by Samuel Epstein (East Ridge Press, 1998).

Epstein charges that the cancer establishment remains myopically fixated on damage control — diagnosis and treatment, and basic genetic research with, not always benign, indifference to cancer prevention research and failure of outreach to Congress, regulatory agencies, and the public with scientific information on unwitting exposures to a wide range of avoidable causes of cancer. The National Cancer Institute (NCI) and the American Cancer Society (ACS) are also accused of pervasive conflicts of interest, particularly with the cancer drug industry.

Leaf CoverThe Truth in Small Doses: Why We’re Losing the War on Cancer-and How to Win It by Clifton Leaf (Simon and Schuster, 2013).

Over the past half century, deaths from heart disease, stroke, and so many other killers have fallen dramatically. But cancer continues to kill with abandon. In 2013, despite a four-decade “war” against the disease that has cost hundreds of billions of dollars, more than 1.6 million Americans will be diagnosed with cancer and nearly six hundred thousand will die from it. A decade ago, Clifton Leaf, a celebrated journalist and a cancer survivor himself, began to investigate why we had made such limited progress fighting this terrifying disease. The result is a gripping narrative that reveals why the public’s immense investment in research has been badly misspent, why scientists seldom collaborate and share their data, why new drugs are so expensive yet routinely fail, and why our best hope for progress—brilliant young scientists— are now abandoning the search for a cure. The Truth in Small Doses is that rare tale that will both outrage readers and inspire conversation and change. Listen to an Interview with Clifton Leaf »

The Truth About the Drug Companies: How They Deceive Us and What to Do About It by Marcia Angell (Random House, 2004).

Written by former editor of the New England Journal of Medicine, Angell reveals how “big pharma” (including corporations such as Pfizer and AstraZeneca) operate by corrupting; Congress through huge campaign contributions; the FDA through partial funding; and members of the medical profession and its institutions through programs disguised as “professional education.” According to Angell, the cost of marketing–both to physicians and consumers– far outweighs expenditures on research and development.

Unnatural History: Breast Cancer and American Society by Robert Aronowitz (Cambridge University Press, 2007).

In the early nineteenth century in the U.S., cancer in the breast was a rare disease. Now it seems to be everywhere. Written by a medical historian who is also a doctor, Unnatural History tells how and why this happened. The book traces changing definitions and understandings of breast cancer, the experiences of people diagnosed with breast cancer, changing clinical and public health practices, and individual and societal fears that impact decision-making. Rather than there simply being more disease, Aronowitz argues that the epidemic proportions of breast cancer incidence may also result from how we have detected, labeled, and responded to the disease. It is a solid account of what has, and has not changed in the knowledge and understanding of breast cancer over the course of the nineteenth and twentieth centuries.

Worried Sick: A Prescription for Health in an Overtreated America by Norton M. Hadler (The Univ. of North Carolina Press, 2008).

Reviewing the data behind many widely accepted practices in modern American medicine, Hadler concludes that most come up too short on benefit and too high on risk. Each chapter of Worried Sick is an object lesson on the uses and abuses of common offerings, from screening tests to medical and surgical interventions. By learning to distinguish good medical advice from persuasive medical marketing, consumers can make better decisions about their personal health care and use that wisdom to inform their perspectives on health-policy issues.  Worried Sick is now available in paperback, with a new preface by the author and a new foreword by Shannon Brownlee and Jeanne Lenzer.

The Secret History of the War on Cancer by Devra Davis (Basic Books, 2009).

Why has the “War on Cancer” languished, focusing mainly on findingand treating the disease and downplaying the need to control and combat cancer’s basic causes—tobacco, the workplace, radiation, and the general environment? As epidemiologist Devra Davis shows in this superbly researched exposÉ, the War on Cancer has followed the commercial interests of industries that generated a host of cancer-causing materials and products. In short, the war has targeted the wrong enemies with the wrong weapons, failing to address known cancer causes.


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