Friday, April 4, 2008

Book Review - Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer

Balanced and thoroughly researched, this book illustrates how the failings of our healthcare system are more complex than simply claiming that insurers are greedy and malpractice insurance premiums are too expensive.

Patients with the same illness are getting more costly medical care in certain parts of the country but actually do worse. The amount of medical care delivered is driven by the number of specialists, hospitals, and technology available in the community. The more doctors and hospitals add new services and technology the more likely those expensive services are used regardless of whether patients need it but because the providers can get paid for it. When organizations and committees try to set up guidelines based on evidence or do research to see if current therapies are effective, special interests and politics kills the initiatives.

Hospitals focus on generating more business in departments which are profitable, like oncology, with newer buildings and the latest medical equipment so that they can afford to run emergency departments which continually lose money. Doctors and patients are enamored with the latest treatments and interventions which often are far more expensive, aren't better than existing therapies, and like the case of bone marrow transplant for metastatic breast cancer patients, are more lethal.

The pharmaceutical industry is intimately linked to doctor education and invariably influences which prescriptions are prescribed and market prescription medications as easily as consumer companies promote common household products. It is money not science that drives the healthcare system.

The author believes that solving the dysfunctional healthcare system requires that doctors and hospitals align themselves into integrated healthcare organizations like the Mayo Clinic, Kaiser Permanente, and the Veterans Health Administration. Unfortunately, however, because she makes such a compelling case of how each of the various providers and businesses each have a financial self interest to keep the current system going at the detriment of patient care, it is difficult to see how the transition will occur, if ever.

If you were asked to set policy for the White House, then this would be the book to get you up to speed on what makes our healthcare system the most expensive in the world and the worst at keeping us healthy. If however you are just trying to navigate through our healthcare system then the book Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System would be a better bet.


Dr. B G said...

I love this book you reviewed!

Do you address primary and secondary CAD prevention in your books and the use of EBT?

Thanks for you interesting blog...


Davis Liu, MD said...

While I do discuss risk factors for heart disease and the use of EBT (electron beam tomography), I don't explicitly discuss treatment options.


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