Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer | Shannon Brownlee

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer | Shannon Brownlee | Raises Serious Issues That Must Be Fixed!

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Overtreated: Why T...

	Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer Shannon Brownlee Bloomsbury USA, 2007 - 352 pages average customer review:based on 25 reviews view larger image
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highly recommended

Easy reading, Hard thinking

This well-written book is easy to read and raises some big questions about what we really want from our health care system. The author has obviously done a lot of research and looks at the history of how we got here, but she also brings it all to life with lots of stories and real examples. I'm a nurse, but I learned new things from reading this and found that it gave me some new perspectives on my work and the experiences of my patients. Definitely recommend it to anyone concerned about the cost and quality of our American health care system.

Raises Serious Issues That Must Be Fixed!

Politicians constantly tell us we have the best health care in the world. Yet, our life expectancy lags that of other developed countries, and a recent study of heart attack patients found Canadians did just as well as Americans - despite spending far less than we do. Waiting for elective surgery or an MRI in other developed nations doesn't account for the difference in spending - the 15 procedures and tests accounting for the vast majority of waiting in other nations only account for 3% of costs in the U.S.

Brownlee goes on to say we devote nearly 33% of spending to administrative costs and profits (I suspect she is high - other sources limit this figure to for-profit health care) - while failing to provide insurance for nearly 50 million, vs. 16% for administrative costs in Canada, which covers everyone. The average cost/day in a U.S. hospital is 4 times the average in the rest of the developed world. The biggest issue, however, is that between 20 and 33% is spent on unneeded care (per a widely quoted study) that often harms the patient (eg. needless radiation, infections).

Why so much extra treatment? Lack of information, a system that pays more for doing more, and cutting back on care smacks of rationing and an overemphasis on economy. Probably the biggest factor, however, is that supply creates demand in health care (Roemer's Law) - the more technology, hospital beds, and specialists available, the more they will be used, and the higher costs will rise. On the other hand, most major surgeries hardly vary between regions - eg. colon cancer, hernia repair; these are the the problem.

Legislation that doubled the number of medical school graduates (especially the number of specialists) between '60 and '80 assumed this would lower costs. Instead, utilization of expensive technology and procedures increased; meanwhile, Medicare reduced or eliminated the incentive to hold down prices, especially for those with limited funds. Regions with fewer specialists and more primary care physicians have better overall health.

Consumer-driven health plans (including health savings accounts) make the absurd assumption (per some health care experts) that patients or their families will monitor and make decisions about their own care when in the hospital - even when a family member is a physician. There is too much practice variation, too many hand-offs between specialists, and too much missing information - eg. drug companies withholding or providing misleading information, and a dearth of randomized clinical trials to scientifically evaluate various alternatives (one expert estimates only 15% of medicine is backed by such research, and that much "research" is seriously flawed - eg. selection bias).

Malpractice fears doe not explain high costs of medicine either - comparisons between states with limitations vs. those without find only a 15% difference in unneeded tests.

One major concern with "Overtreated" is that I suspect its estimates of excess costs and deaths are overstated. Examples include the previously referenced instance of overhead costs in the U.S., and the estimates for deaths caused by errors - eg. the 80,000 quoted in the well-known Institutes of Medicine, PLUS another 400,000 for drug errors, PLUS thousands more for excessive chemotherapy administered to breast-cancer patients, etc. However, the book's basic assertions are soundly backed up.

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To Protect Yourself You Must Read This Book!

Shannon Brownlee's manifesto, Overtreated, is a an extraordinarily important volume for those of us who question the mercantile thrust of health care in these United States. The sad reality is that to many physicians, hospitals, insurance carriers, and, of course, most pharmaceutical companies the American patient is a valuable cash cow. This impeccably researched book will allow the reader to make informed health care decisions. It is lucidly written and difficult to put down. It should be required reading for all who find themselves on the consumer end or "health care." As a physician, I will keep copies in my office for patients to peruse and borrow. Thank you, Ms. Brownlee for shedding light on a dimly lit landscape.

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Don't just do something - stand there!

This is an extremely important book to read for anyone who has or will come into contact with the healthcare industry - that is pretty much every single person alive in the USA. The current health care system is broken very badly. The media and politicians talk about it but not enough. The problem is far more serious than any national issue. The US spends over 15% of its GDP per capita on health care which is by far the greatest amount compared to other nations. What do we get for it? According to WHO the our outcomes are roughly comparable to Chile (worse than Greece). For outcomes, I am using "Life expectancy at birth", "Healthy life expectancy at birth", and "Probability of dying between 15 and 60 years". (See http://www.who.int/countries/usa/en/). Chile spends only about 6% of their GDP on healthcare. There are lots of reasons for this poor performance but Brownlee discusses one that is rarely talked about which happens to be the most important reason. That reason is overtreating.

Brownlee has done her research very well and presents a well balanced (until the last chapter but more on that later) account of why our current system leads to overtreating. She discusses the three main reasons as being 1) fear of malpractice law suits by physicians (ie: doctor orders head CT scan for a patient with a headache even though chances of brain tumor is very small). The second reason is consumer demand (ie: patients demanding unnecessary tests) and finally financial incentives and culture in medicine (From early on medical students are taught to gain as much information as possible hence leading to unnecessary tests and procedures). All 3 reasons are valid. Perhaps Brownlee underestimates the importance of the first two reasons.

The reason I gave this book 4 stars instead of 5 was because of my disappointment at the final chapter. In the final chapter she proposes some solutions. Throughout the book I was excited to hear her solutions. Given her insights and brilliant research, I expected well thought of solutions with solid backing. She basically proposes copying the VHA (Veterans Health Administration) or HMO's like Group Health. She also touts electronic record keeping. She ignores the problems that will undoubtedly arise from the proliferation of these systems. For example, she states that under the current system physicians have perverse financial incentives to perform procedures since they get paid for each procedure. Under a system, where physicians are salaried like Group Health or VHA, physicians would have perverse incentives NOT to do appropriate procedures. Why would that system not lead to undertreating? Furthermore she begrudges drug companies like Pfizer for having gross margins of 27%, considerably higher than GE and Walmart. One cannot compare a drug company's single financial stats with another company in a different industry. Brownlee ought to know that better. Had she used gross profit then both GE and Walmart would have profits more than twice Pfizer's. In any case it should not be the government's job to keep track of companies' profitability in a capitalistic system.

In all fairness to Brownlee, US Healthcare system is very complicated and perhaps she should not have tackled solutions at this point. I look forward to a sequel where she has more thoughtful solutions with solid microeconomic foundations. In any case, this is a must read and she has done an excellent job (until the final chapter).

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reviews: 1, 2, 3, 4, page 5

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