Martensen, a physician, dares to question the medical establishment's reliance on high-tech interventions, especially among the elderly. He shows that many of these interventions are unnecessary and even harmful.
On a broader scale, he reminds us that over 50% of our medical spending comes from the "public purse" in huge amounts, while every day people die because they can't afford basics like insulin. Most shocking: In 1600, if you made it to age 80 in Berlin, you could expect to live another eight years. In 1980, a study found that if you reached age 80 in the same city, your life expectancy was 88: just two more years (p. 79).
Martensen illustrates his points with stories taken from his many years as emergency physician and bioethicist. One of the most chilling accounts describes a woman who remained healthy and active through her seventies, when she began experiencing shortness of breath while enjoying her long walks. A cardio surgeon suggested an operation. The operation worked to restore the woman's breathing - but the woman now experienced dementia. She was afraid to go out and her quality of life deteriorated.
The woman's son asked Martensen about the possibilities of a lawsuit. Dementia is a known side effect of this type of surgery, so why hadn't the surgeon discussed it? Martensen warned the son, "You're in a field where you do a lot of negotiating. Your mother at the time ran her own craft business. The risks are here, buried in the fine print."
My own view is that the surgeon should still have gone out of her way to warn about risks, especially such serious risk. I would have encouraged them to sue (if they had means ) to teach the surgeon (and other surgeons) a strong lesson. Doctors tend to see risks abstractly. I once expressed concern about an eye problem to a doctor who seemed fairly sensitive. He said, "Well, if that eye goes, you'll still have one more." I'm still blown away. In all fairness, there was very little likelihood I would lose vision, but statistics feel different when they're about you.
Finally, Martensen talks about the uncertainties of high-tech medicine. We know that a certain percentage of people with certain conditions will recover, but we don't know which episode will be fatal and which episode deserves a high-tech response. At the end of life, UCLA patients spend three times more days in the ICU than UCSF patients, with no increase in quality or length of life.
This book should be required reading for everyone. We need to recommend this book to our legislators and take a copy when we visit medical practitioners. This book will be especially helpful to readers who have aging parents or who are aging themselves, because we need to set up safeguards to avoid useless, invasive end of life "care."
The author's own father was saved from a painful death only because family members had the paperwork in hand when the father went to the emergency room. Most of us wouldn't be so lucky.
