Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer [Paperback]

Shannon Brownlee (Author)

Book Description

Release date: September 2, 2008

“My choice for the economics book of the year…it’s the best description I have yet read of a huge economic problem that we know how to solve—but is so often misunderstood.”—David Leonhardt, New York Times

Our health care is staggeringly expensive, yet one in six Americans has no health insurance. We have some of the most skilled physicians in the world, yet one hundred thousand patients die each year from medical errors. In this gripping, eye-opening book, award-winning journalist Shannon Brownlee takes readers inside the hospital to dismantle some of our most venerated myths about American medicine. Brownlee dissects what she calls “the medical-industrial complex” and lays bare the backward economic incentives embedded in our system, revealing a stunning portrait of the care we now receive.

Nevertheless, Overtreated ultimately conveys a message of hope by reframing the debate over health care reform. It offers a way to control costs and cover the uninsured while simultaneously improving the quality of American medicine. Shannon Brownlee’s humane, intelligent, and penetrating analysis empowers readers to avoid the perils of overtreatment, as well as pointing the way to better health care for everyone.

With a new afterword offering practical advice to patients on how to navigate the health care system.

Editorial Reviews

From Publishers Weekly

Starred Review. Contrary to Americans' common belief that in health care more is more—that more spending, drugs and technology means better care—this lucid report posits that less is actually better. Medical journalist Brownlee acknowledges that state-of-the-art medicine can improve care and save lives. But technology and drugs are misused and overused, she argues, citing a 2003 study of one million Medicare recipients, published in the Annals of Internal Medicine, which showed that patients in hospitals that spent the most were 2% to 6% more likely to die than patients in hospitals that spent the least. Additionally, she says, billions per year are spent on unnecessary tests and drugs and on specialists who are rewarded more for some procedures than for more appropriate ones. The solution, Brownlee writes, already exists: the Veterans Health Administration outperforms the rest of the American health care system on multiple measures of quality. The main obstacle to replicating this model nationwide, according to the author, is a powerful cartel of organizations, from hospitals to drug companies, that stand to lose in such a system. Many of Brownlee's points have been much covered, but her incisiveness and proposed solution can add to the health care debate heated up by the release of Michael Moore's Sicko. (Sept.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

From Booklist

*Starred Review* Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is. In a step-by-step deconstruction of America's improvident health-care system, Brownlee sheds light on events, attitudes, and legislation in the twentieth century's latter half that led to this economic nightmare. With the skill of a crack prosecuting attorney, she cites specific cases of physician and hospital fiscal abuse. Her aim is broad but not scattershot as she hits not just docs and hospitals but private insurers, Medicare, patients, medical device manufacturers, and pharmaceutical companies by, for instance, quoting a pharmaceutical salesperson who confesses financing a physician's swimming pool to get the doc to write more prescriptions. She is not all bad news, though, for she posits models that could be adapted to create a nationwide health-care system that conceivably could staunch the current fiscal hemorrhaging. If only. Chavez, Donna --This text refers to an out of print or unavailable edition of this title.

See all Editorial Reviews

Product Details

• Paperback: 368 pages
• Publisher: Bloomsbury USA; 1 edition (September 2, 2008)
• Language: English
• ISBN-10: 1582345791
• ISBN-13: 978-1582345796
• Product Dimensions: 8.2 x 6.4 x 1 inches
• Shipping Weight: 9.6 ounces (View shipping rates and policies)
• Average Customer Review: 4.4 out of 5 stars  See all reviews (60 customer reviews)
• Amazon Best Sellers Rank: #27,646 in Books (See Top 100 in Books)
  • #9 in Books > Medical Books > Administration & Medicine Economics > Health Care Administration
  • #34 in Books > Medical Books > Administration & Medicine Economics > Health Care Delivery

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Most Helpful Customer Reviews

95 of 96 people found the following review helpful

5.0 out of 5 stars HELP! - Healthcare Reform Needed!!!!! March 5, 2008

By Mark W. Ketterer

Format:Hardcover

Read this book.

If you are in the American healthcare system, this is the single most important book you will ever read. If you are in a healthcare system that is moving towards "privatization" or "free market reform", this may be the most important book you will ever read. If you are a behavioral scientist interested in the role of behavioral factors in medical populations, this is the most important book you will ever read.

A science journalist with a real science background (an M.S. in Biology) and now a Fellow at the New America Foundation, Brownlee has brought together many strands of research to provide us with a picture of the core dilemma in the american health care system - why do we spend so much more than other industrialized countries while not producing better outcomes? At 16% of Gross Domestic Product (and climbing), the American healthcare system is 60-100% more expensive than any other industrialized country and yet we do not live as long as citizens there. Where all these countries cover 100% of their citizens, the American system leaves about 15% of its population (about 47 million people) uncovered at any one time (and even more if you include loss of coverage for extended periods, but not a whole year). Fifty percent of bankruptcies in the U.S. are due to medical bills. Americans avoid switching jobs for fear of losing coverage for pre-existing conditions. The U.S. manages to achieve these colossal failures while still expending 62% of all costs through the government (if civilian government employee's coverage is included as part of the government supported costs)....

While there are many contributing problems (profiteering by insurance and drug companies, a system which rewards physicians for doing more rather than just what is proven effective, malpractice anxiety leading to defensive practice, lack of coverage for primary preventive and mental health care which could avoid more expensive emergency care, etc.), Brownlee demonstrates that the core issue is a lack of clinical research to guide physician's decision-making. Where ambiguity exists (and it exists in up to 80% of healthcare), variability in "standard" care is great, and unnecessary care and expense mounts. As a comic strip character once observed: "We have met the enemy, and he is us."

Starting with the studies by John Wennberg and the Dartmouth Center for Evaluative Clinical Sciences, Brownlee reviews the high level of variability (up to seven fold) in the use of various procedures across the U.S. Wennberg's observation is that in U.S. healthcare, "geography is destiny". The kind of treatment you receive depends upon where you live, not what your illness is. And the characteristic most strongly associated with unnecessary care is the number of specialists. If we build it, they will come. The normal operation of a free market is distorted in healthcare by: socialization of costs; the desperation of patients and families; the vast difference between "buyers" (patients) and "sellers" (practitioners, hospitals, drug companies) in understanding what actually works and the tradeoffs in outcomes; and the placebo effect and spontaneous remission. But isn't it part of our duty to protect patients from unproven, and potentially harmful, interventions? If outcomes were improved in the more aggressive geographic areas of the country we might be able to claim that the less costly areas are undertreated, but they are not. In fact, in most comparisons, patients are, if anything, worse off with the more aggressive care. Remember that Hippocratic dictum: "Primum, non nocere" (First, do not harm)? The propensity of U.S. healthcare is to "do something" rather than accepting the patient's status as perhaps better than the potential harm occasioned by aggressive intervention. For those of us raised in the era of "If it might help, do it", this is tough medicine to swallow. But it is necessary medicine.

Brownlee acquaints the reader with many of the more egregious failures of the system: back surgery for chronic low back pain; mastectomy (vs lumpectomy) in breast cancer; bone marrow transplantation in breast cancer; PTCA for event, or even chest pain, reduction in coronary heart disease; fen-phen for weight loss; carotid
endarterectomy in asymptomatic patients; surgery for prostate cancer, etc.

One implication of all this is that the highest priority for medical research should be clinical trials that clarify the effectiveness, safety and efficiency of various treatments. The hostility of the NIH to this task is captured by a quote from its director: "We don't do Coke versus Pepsi". Fine. If the NIH is uninterested in improving American healthcare (it's congressionally mandated mission), defund the NIH and put the money into the Agency for Healthcare Policy and Research - the folks who blew the whistle on back pain surgery and were subsequently assaulted by the Orthopods bribing Congress. The priorities for public funding should exactly answer us about "Coke versus Pepsi", because that's where lives are won or lost. Cellular, subcellular and genetic research has such a low rate of clinical payoff that it ought to be the minor theme. Read more ›

74 of 77 people found the following review helpful

5.0 out of 5 stars To Protect Yourself You Must Read This Book! September 20, 2007

By DJE

Format:Hardcover|Amazon Verified Purchase

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.

44 of 45 people found the following review helpful

5.0 out of 5 stars Protect yourself--and the ones you care about--by reading this book!!! March 10, 2008

By Stephen Pletko TOP 1000 REVIEWER

Format:Hardcover

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"[This book] is an exploration of three simple questions:

(1) What drives unnecessary health care?
(2) Why should we worry about it?
(3) And once we understand how pervasive it is in American medicine, how can we use that knowledge to create a better system?"

The above is found in this stunning, eye-opening book authored by medicine, health care, and biotechnology and award-winning journalist Shannon Brownlee.

Note that even though this book concentrates on the American healthcare system, what it says can be applied to the Canadian and European systems as well.

People familiar with the problems in healthcare will be familiar with some of the contents of this book. What they won't be familiar with is the true-life patient and whistle-blower stories (many of them ending up tragically) that Brownlee discusses to drive home the points she makes.

Almost every page has something interesting on it. I will provide a sample sentence from each chapter of this gripping book (these are just the tip of the iceberg):

(1) "As research would show over the coming decades, stunningly little of what physicians do has ever been examined scientifically, and when many treatments and procedures have been put to the test, they have turned out to cause more harm than good."
(2) "Every patient admitted to a hospital risks being hurt or even killed by the very people who wish to help her."
(3) "After blowing the whistle on the hospital and its specialists, he would lose practically everything he valued, his medical practice, his family, and his home."
(4) "The supply of medical resources, rather than the underlying needs of patients, is determining how much medical care they get...."
(5) "How is it that a dangerous, highly experimental treatment came to be given to thousands of women before it had been adequately tested?"
(6) "Even as the number of [medical] imaging tests [X-ray, CT, MRI] is going up, numerous studies suggest that all those pictures are not nearly as effective at improving diagnosis as many doctors--and patients--tend to think."
(7) "On Thursday, three weeks after Justin swallowed his first antidepressant [prescribed to him by a university doctor], his roommate walked into their apartment to find his friend dead [of suicide]."
(8) "The drug company representative, or drug rep, usually [is] a handsome young man or shapely young woman who has been recruited more for his or her good looks and outgoing personality than for his or her aptitude for science or medicine."
(9) "The more specialists involved in your health, the more likely it is that you will suffer from a medical error, that you will be given care you don't need and be harmed by it."
(10) "The Institute of Medicine estimates that only 4 percent of treatments and tests are backed up by strong scientific evidence; more than half have very weak evidence or none."

Finally, if you want to seriously investigate this topic more, I recommend two classic books:

(1) "Confessions of a Medical Heretic" by an American doctor.
(2) "The Medical Mafia" by a French-Canadian doctor. (This conscientious doctor lost her medical license for having written this book.)

In conclusion, if your satisfied with the medical system, then there is no reason to read this book. But if you're not and what to protect yourself and your loved ones, then read this well-researched book and prepared to be stunned!!

(first published 2007; introduction; 10 chapters; main narrative 305 pages; acknowledgements; notes; index; a note on the author)

<<Stephen Pletko, London, Ontario, Canada>>

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27 of 30 people found the following review helpful

4.0 out of 5 stars Don't just do something - stand there! December 4, 2007

By Houman Tamaddon

Format:Hardcover

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 [...] 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). Read more ›