Sorry, this item is not available in
Image not available for
Color:
Image not available

To view this video download Flash Player

 


or
Sign in to turn on 1-Click ordering
More Buying Choices
Have one to sell? Sell yours here
Tell the Publisher!
I'd like to read this book on Kindle

Don't have a Kindle? Get your Kindle here, or download a FREE Kindle Reading App.

Last Well Person: How to Stay Well Despite the Health-care System [Hardcover]

by Nortin M. Hadler
4.1 out of 5 stars  See all reviews (29 customer reviews)

List Price: $49.95
Price: $37.51 & FREE Shipping. Details
You Save: $12.44 (25%)
o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o
Only 2 left in stock (more on the way).
Ships from and sold by Amazon.com. Gift-wrap available.
Want it tomorrow, April 25? Choose One-Day Shipping at checkout. Details
Free Two-Day Shipping for College Students with Amazon Student

Formats

Amazon Price New from Used from
Hardcover $37.51  
Paperback $17.23  
Unknown Binding --  
Sell Us Your Books
Get up to 80% back when you sell us your books, even if you didn't buy them at Amazon. Learn more

Book Description

September 15, 2004 0773527958 978-0773527959 1
Are we all diseased time bombs? In The Last Well Person Dr Nortin Hadler argues that unfounded assertions, massaged data, and flagrant marketing have led to the medicalization of everyday life. He systematically builds the case that constant medical monitoring and unnecessary intervention are hazards to our health, severely reducing our quality of life. Sick with worry, we are a culture panicked by many illnesses - cardio-vascular disease, obesity, adult onset diabetes, fatigue, and breast cancer. Especially insidious, contends Hadler, is the misuse of longevity statistics in turning the difficulties experienced through a natural course of life, such as aging, back pain, and osteoporosis, into illnesses. He shows that the medical profession's current notion that such predicaments can be avoided is fatuous and self-serving. And he argues that most heart bypass surgery, mammography, cholesterol screening, and treatment to prevent prostate cancer should be avoided.

Frequently Bought Together

Last Well Person: How to Stay Well Despite the Health-care System + Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) + Stabbed in the Back: Confronting Back Pain in an Overtreated Society
Price for all three: $94.21

Buy the selected items together


Editorial Reviews

From The New England Journal of Medicine

One of my favorite articles in the medical literature appeared in these pages a little more than a decade ago. "The Last Well Person" (N Engl J Med 1994;330:440-1) was an Occasional Note written by a Tennessee physician, Clifton Meador. It was a fictional scenario that was to take place in the not-too-distant future. The lone character was a 53-year-old professor of freshman algebra at a small college in the Midwest. Despite extensive medical evaluation, no doctor had been able to find anything wrong with him. But he was the only remaining person for whom this was true. Although it was just a story, Meador warned that "if the behavior of doctors and the public continues unabated, eventually every well person will be labeled sick." I share his concern about our proclivity for diagnostic labels and went on to write a book on the topic, specifically as it applies to the increasingly frequent diagnosis of cancer. In mentioning this, my intention is to disclose two opposing potential conflicts of interest -- a commitment to the topic and authorship of a competing work -- that might influence my review of Nortin Hadler's book, which pays tribute to Meador's article by using the same title. Hadler is worried about our increasing tendency to overtreat and overdiagnose. In the first section of the book, he assails the current practices that are relevant to the two most common causes of death in Americans: heart disease and cancer. He suggests that the current management of myocardial infarction and angina "veers towards Type II Medical Malpractice" (treatment is not needed), that coronary bypass surgery benefits only a fraction of the patients who undergo it, and that, although it is a gentler procedure, angioplasty is just as bad. He goes on to suggest that the reduction in absolute risk is too small to warrant cholesterol reduction in the population at large and that the efforts to address the so-called metabolic syndrome (lipid disorder plus obesity, diabetes, and hypertension) with diet and exercise are misguided. His assessment of cancer prevention is equally stark: screening for colorectal cancer will "not affect mortality from all causes," mammography produces "almost nothing of value," and "no man should think that [prostate] surgery will increase his time on earth." It is a brutal critique of much of what we do in medicine. Although Hadler has an extremely high threshold by which to call something beneficial (for a hard outcome such as death, his preferred cutoff is an absolute-risk reduction of at least 5 percent), and although he fails to highlight just how tricky it is to know which patients are among the few who will benefit, it is a critique that thoughtful clinicians will want to read. Hadler's message to the general public is simple: resist most interventions that promise to modify and mollify mortal risks through "hippie-dippie" (HP-DP -- health promotion and disease prevention). Unfortunately, the rationale for this resistance may be less accessible, since important concepts such as confounding, false positive rates, numbers needed to harm, and statistical significance are invoked but not explained. Hadler is also worried about our increasing tendency to "medicalize" common problems. In the second section of the book, he reviews what will be familiar ground for primary care practitioners -- that much of our work involves helping persons who seek relief from symptoms. Here he draws on his experience as a rheumatologist, questioning the usefulness of (or need for) treatment for backache, knee pain, fibromyalgia, and osteoporosis. But the point is more general: "None of us will live long without headache, backache, heartache, heartburn, diarrhea, constipation, sadness, [or] malaise." One choice is to "deal with it"; the other is to seek care and become "a patient or a client with an illness or a condition -- and, likely, forever." Hadler is clearly advocating the former, but his vision of how this might happen is less clear. Although the case he makes for staying away from medical care is compelling, he does not detail any alternative coping strategy. Unfortunately, when it comes to common medical symptoms, a coping strategy is what people really need in order to stay well. H. Gilbert Welch, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

'"Hadler is a superb teacher. The reader learns to think independently and to reason critically about the many unsupported or unsupportable claims made on behalf of modern medicine, including much of modern pharmacology, surgery, and so-called alternative medicine. A must-read for both medical professionals and ordinary folk." Arthur Schafer, director, Centre for Professional and Applied Ethics, University of Manitoba

Product Details

  • Hardcover: 313 pages
  • Publisher: Mcgill Queens Univ Pr; 1 edition (September 15, 2004)
  • Language: English
  • ISBN-10: 0773527958
  • ISBN-13: 978-0773527959
  • Product Dimensions: 9.3 x 6.4 x 1 inches
  • Shipping Weight: 1.3 pounds (View shipping rates and policies)
  • Average Customer Review: 4.1 out of 5 stars  See all reviews (29 customer reviews)
  • Amazon Best Sellers Rank: #192,774 in Books (See Top 100 in Books)

More About the Author

BIOGRAPHICAL SKETCH

Nortin M. Hadler, MD
MACP, MACR, FACOEM

Dr. Hadler is a graduate of Yale College and The Harvard Medical School. He trained at the Massachusetts General Hospital, the National Institutes of Health, and the Clinical Research Centre in London. He was certified a Diplomate of the American Boards of Internal Medicine, Rheumatology, Allergy & Immunology and Geriatrics. He joined the faculty of the University of North Carolina in 1973 and was promoted to Professor of Medicine and Microbiology/Immunology in 1985. He serves as Attending Rheumatologist at the University of North Carolina Hospitals.
He has lectured widely, including many named lectureships, and is a frequent commentator for the print and broadcast media. He has garnered multiple awards and served lengthy Visiting Professorships in England, France, Israel and Japan. He was selected as an Established Investigator of the American Heart Association and has been elected to membership in the American Society for Clinical Investigation and the National Academy of Social Insurance. He has been elevated to Master of the American College of Physicians and the American College of Rheumatology and is a Fellow of the American College of Occupational and Environmental Medicine.
The molecular biology of hyaluran and the immunobiology of peptidoglycans were the focus of his early investigative career to be superseded by his fascination with what he initially termed "industrial rheumatology." For 30 years he has been a student of "the illness of work incapacity"; over 200 papers and 12 books bear witness to this interest. He has detailed the various sociopolitical constraints imposed by many nations to the challenges of applying disability and compensation insurance schemes to such predicaments as back pain and arm pain in the workplace. He has dissected the fashion in which medicine turns disputative and thereby iatrogenic in the process of disability determination, whether for back or arm pain or a more global illness narrative such as is labeled "fibromyalgia." He is widely regarded for his critical assessment of the limitations of certainty regarding medical and surgical management of the regional musculoskeletal disorders. The third edition of his monograph, Occupational Musculoskeletal Disorders, was published by Lippincott Williams & Wilkins in 2005 and provides a ready resource as to his thinking on the regional musculoskeletal disorders.
In the past decade, he turned his critical razor to much that is considered contemporary medicine at its finest. His assaults on medicalization and overtreatment appear in many editorials and commentaries and 4 recent monographs:
McGill-Queens University Press published The Last Well Person. How to stay well despite the health-care system in 2004 (paperback 2007). UNC Press published Worried Sick. A prescription for health in an overtreated America (2008, paperback 2012), Stabbed in the Back. Confronting back pain in an overtreated society (2009), and Rethinking Aging. Growing old and living well in an overtreated society (2011). A fifth book, Citizen Patient, is in press and scheduled for release early in 2013. Les Presses de l'Université Laval / Les Éditions de l'IQRC is the publisher of French translations: Le Dernier des Bien Portants (2008), Malades d'inquiétude (2010), Poignardé dans le dos (2011) - won Prix Prescrire in 2012, and Repenser le vieillissement (2012, in press).

Customer Reviews

Most Helpful Customer Reviews
52 of 55 people found the following review helpful
Format:Hardcover|Verified Purchase
This is an outstanding book that decries many components of traditional and alternative medicine. It is very informative to manage your own health in a more independent, cost-effective, and dignified way than otherwise. According to the author all our ills that truly result mainly from the natural process of aging have been "medicalized" at no benefit to the patient. But in turn, this medicalization has generated huge profits for the health care industries.

The author has impressive credentials to advance his views. He is a professor of Medicine at one of the top U.S. public universities, and he is a practicing rheumatologist. Additionally, he has a strong background in statistics that he uses to interpret the objective results of random trials before spin doctors promote questionable benefit of whatever drug tested. Also, his "opinions' are well supported by 60 pages of references to random trials mentioned in the "Annoted Readings" section of the book.

Human beings have a mean expected life span of 85 years. Advances in medical technology has done nothing to extend this life span. With aging, a bunch of proximate diseases (cardiovascular, cancers, and others) compete with each other to end our days. Thus, often the well publicized reduction in mortality for a certain type of cancer due to a treatment has no implication in extending one's life span for a single day. A survivor of prostate cancer may die at the exact same time he would have died of cancer but from cardiovascular disease. The author has analyzed many related random trials that confirmed this.

"Medicalization" is in his view an artificial social construct whereby a condition (back or knee pain) has been turned into a disease.
Read more ›
Was this review helpful to you?
47 of 50 people found the following review helpful
Format:Hardcover
+++++

Answer true or false to these ten statements:

(1) Cardiovascular surgery clearly and unequivocally benefits the patient.

(2) Even though obesity (which is unhealthy) is on the rise in America, American life expectancy is increasing.

(3) There are very reliable methods for screening that spares us the risk of dying from colorectal cancer before our time.

(4) Mammography is of much value to the women screened.

(5) Prostate gland screening for males doesn't work.

(6) It is abnormal to live two years without a backache.

(7) One of the potentially dangerous acts physicians perform is to take a "history" from a patient.

(8) Bone thinning is an insidious illness.

(9) Psychological and social stress is not all bad.

(10) There is compelling evidence that acupuncture, physical therapy, massage, therapeutic touch, and distant healing work for physical complaints.

If you answered true to any one of statements (1,3,4,8,10) or false to any one of statements (2,5,6,7,9), then you may benefit from this enlightening book authored by medical professor Dr. Nortin Hadler.

Hadler explains the purpose of his book:

"[This book] is written for all those well people who feel their sense of well-being is under attack...It is crafted to inform the reader who is well and how to feel well...[It] is a treatise on medicalization that is informed by science, clinical reality, and an analysis of life's morbid experiences-even episodes of disease...And I will explain how to avoid iatrogenicity-medical interventions that cause harm...Teaching the well how to approach the act of medical treatment critically is something of a heresy...
Read more ›
Was this review helpful to you?
71 of 78 people found the following review helpful
5.0 out of 5 stars Words To Live By May 17, 2005
Format:Hardcover|Verified Purchase
When Nortin Hadler's book, "The Last Well Person," came my way, I realized my mother fit his titular profile to a tee. She lived to 84, just one year short of the ripe old age Hadler believes may be the fixed limit for our species. Her death from cancer, after a full life, did not bankrupt her spiritually or financially. Her body was not wasted by debilitating treatments capable only of keeping her alive a little longer-because she chose not to have any. Her decline began only shortly before her death. She benefited greatly from the palliative care she sought when she could no longer cope with the symptoms she was experiencing. (If you want to read her story, link to "Luck of the Dying" in the May-June 2005 issue of Health Affairs:

[...]

I practiced as a nurse for thirty-five years, twenty of them as a family nurse practitioner in a clinic providing primary health care to people of all ages and long term care to the elderly and dying in their homes. Close observation of my patients' experience with health care taught me that less is more when it comes to prescribing pills and procedures and that, especially for my elderly patients, supportive nursing care was, more often than not, the most effective treatment.

Yes, there are sections in Hadler's book that may prove tough slogging for readers unfamiliar with medical terminology or statistical methods, but it's well worth the effort. I wish I could afford to put a copy into the hands of every one of the people I most care about.
Comment | 
Was this review helpful to you?
Most Recent Customer Reviews
3.0 out of 5 stars mixed bag
On the one hand, this book acknowledges the overmedicalizing of life and how in many cases longevity is determined by factors like socioeconomic status. Read more
Published 10 months ago by reader
4.0 out of 5 stars Are You a Patient or a Person?
I've been a nurse for 35 years and have written two books about self-care and the medical system, available on Amazon. Read more
Published on May 3, 2011 by David Spero
4.0 out of 5 stars Great read but........
The only criticism of this book is that Dr. Hadler's writing style is more suitable for his colleagues, rather than the average reader. Read more
Published on February 17, 2011 by Win231
1.0 out of 5 stars Not convinced....
Although Hadler does make sense, I believe he takes too much of a step back & wait approch the could severly damage someone's life. Read more
Published on April 13, 2010 by not crazy after all
4.0 out of 5 stars Doctors can treat too much
This book opened my eyes to something I was almost totally ignorant of, that medical treatment is often based on anecdotal motivation, not on a scientific basis. Read more
Published on January 23, 2010 by Jim Gerdy
5.0 out of 5 stars A MUST READ !!!!!!!!!
My title says it all. Do not be taken in by the scamming health care industry-
it is the 3rd leading cause of death in the US. Read more
Published on October 25, 2009 by Herman
5.0 out of 5 stars A Must Read for the Heath Conscious
This book contains some info that should be important to anyone who is truly concerned about making the right healthcare choices - particularly those already wary of medical... Read more
Published on June 28, 2009 by Joe R
5.0 out of 5 stars What happens when your medical care is paid for by other peoples'...
This is a great, iconoclastic book.

This book isn't the easiest to read....it gets into many technical issues of research design etc..... Read more
Published on October 17, 2008 by Chenango
5.0 out of 5 stars Physician Review of The Last Well Person
I have been a practicing physician for many years.
I learned a great deal from this book. The author is a recognized
authority . Read more
Published on February 14, 2008 by Graenum R. Schiff
4.0 out of 5 stars Ignore your doctor but take care of yourself.
As a practicing physician I approached this book with some skepticism. Even though the reasoning is at time flawed and incomplete the essential message is clear. Read more
Published on December 12, 2007 by Farnorthtx
Search Customer Reviews
Only search this product's reviews
ARRAY(0xa4f6dcc0)





Sell a Digital Version of This Book in the Kindle Store

If you are a publisher or author and hold the digital rights to a book, you can sell a digital version of it in our Kindle Store. Learn more

Forums

There are no discussions about this product yet.
Be the first to discuss this product with the community.
Start a new discussion
Topic:
First post:
Prompts for sign-in
 



Look for Similar Items by Category