Customer Reviews

Severed Trust: Why American Medicine Hasn't Been Fixed

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American medicine is a classic paradox, offering the best of the best alongside an embarrassing failure to provide decent care for millions.

If you have ever puzzled over how this situation came to be, Severed Trust provides an easy-to-understand, well-written explanation. This book is partly the autobiographical odyssey of America's most famous medical editor, George Lundberg, partly a social and political history of American medicine, and partly Dr. Lundberg's vision of the future, detailing what he believes must be done to put our house in order. There are rich and interesting stories alongside important historical information and discussions of social policy issues that in so many other books are......well, just boring.

The son of economically impoverished Alabama schoolteachers, Dr. Lundberg was inspired to enter medicine by his family doctor. He took his first job in medicine mopping floors at a local hospital. After medical school and a distinguished career in pathology; his greatest medical contributions started, first in the 1980s as editor of JAMA, the Journal of the American Medical Association, and, since 1999, as editor in chief of Medscape ... .

In this book, and at JAMA and Medscape, Lundberg relentlessly challenges us to think about issues that hurt the quality, availability, and compassion of care: Why is high-tech medicine, especially at the end of life, often foisted upon patients at great expense, and at times, in nonsensical and inhumane ways? Why are autopsy rates so low in the United States when it has been conclusively proven that autopsies are critical to high quality standards? Can we provide good preventive care for all Americans and if so, why don't we?

Woven through the hard data presented in the book are Lundberg's personal anecdotes from experiences with family, friends, colleagues and articles he has introduced into public discussion and debate.

Lundberg passionately believes that information is powerful medicine, and that by publishing scientifically-sound evidence society will take note, and people, professionals, markets, and politicians will join together to root out bad practices and make the world a better place. The realist in him knows it often doesn't work out that way. But sometimes it does, and the victories, failures, and recommendations are reported in the book with memorable, edgy style (bemoaning the state of autopsies, Lundberg declares "it is time for good pathologists to come out of their clinical labs and spend more time in the morgue.")

Whether you agree or disagree with Lundberg's analyses or proposed fixes, I learned a lot about medicine, health care - and, George Lundberg - from this book, and enjoyed reading it.

Peter Frishauf Founder, [Medscape] Senior Adviser, Medscape, Inc.

(Disclosure: This reviewer recruited Lundberg to Medscape In 1999, after Lundberg was fired by the AMA for publishing the now famous study on the "Is Oral Sex, Sex?" question during the Clinton impeachment hearings)

Dr. Lundberg is a no nonsense, straight talking critic of the current American medical system. I found his historical perpective on how we got to today's, arguably poor, state of medicine fascinating. Dr. Lundberg is highly critical of America's technically excellent but flawed system. He criticizes costly over used medical testing and the highly technical medicine practiced in America today.He compares it with the more caring and cheaper general practitioner sytstem of 30-40 years ago. We want it all from medicine today but at what cost, says Lundberg.Are we all entitled to unlimited expensive services no matter what the cost when we fail to cover 42 million Americans for the most basic services. Is that the right outcome for our highly technical specialized medicine. Where is the preventive medicine? He believes we have a sytem to treat the sick but not prevent illness.

Lundberg blames many forces; greedy doctors, insurance companies, government, consumers, managed care. Some of his criticisms seem overly harsh. For example he would ban any consumer advertising of medical products. This is one solution to high costs he claims.Many older, cheaper midcines do just fine ,he says. What about the fact that American's like to be informed of new treatments. Can't the informed consumer make their own judgements after asking their doctor. Isn't consumer knowledge and advocacy a positive, especially when many of the newer,more effective drugs are resisted by managed care because they are expensive.

Lundberg's critique is a must read for those involved in any phase of the medical system. While many will not agree with his assessment, he does represent a solution: politically difficult but a solution that would be acceptable to many constituencies.

For such a critical issue it is dissapointing how few books exist on this subject. Lundberg's is the best available.

Severed Trust provides an insightful view of American medicine intended for a wide audience ranging from patients to policy-makers. Lundberg speaks from experience, intellectualism, and the heart, providing a comprehensive review of many of the current problems inherent in medicine and offers solutions for change. In the past, he often brought attention to many sensitive healthcare issues including addiction, violence, nuclear war, abortion, physician assisted suicide, death and dying, medical mistakes, and inequity of care. In this captivating book, he effectively brings these issues together, highlighting the contribution of each in the complexity of today's medicine. Leaving no stone unturned, he points out the many negative attributes of competing interests from profit to politics and contends that these interests threaten the quality of healthcare. He asserts that a balance exists between medicine as a business (economic incentives) and as a profession and warns that if this delicate balance continues to tip more toward economics and self-interest then society will rise up and take our professional privileges away. Importantly, he also calls attention to the profound $1.2 trillion annual cost of medical care that excludes 40 million uninsured Americans, pointing out the illogical provisions for unnecessary procedures and futile care rather than for preventive services and basic medical care. He proposes many solutions for fixing our healthcare system that deserve serious consideration and finally, he provides a vision for a system that provides better efficiency and good quality of care for all.

I have studied public health and worked as a public health professional for more than eight years. Intially my impression, upon reading Severed Trust, was that I'd heard much about the need to fix our broken health care system before but never from a physician, particularly from the former editor-in-chief of the Journal of the American Medical Association. The author, Dr. George Lundberg, suggests a major overhaul of the US health care system, including the insurance industry, the pharmaceutical industry and the profession of medicine.

Some of Dr. Lundberg's ideas are pretty radical: eliminating insurance except for preventive care and catastrophic care, a complete ban of pharmaceutical advertising to the public (which was in force until the 1980s), limitations of one transplant organ per person - no second chances after a transplanted organ fails, "rational rationing" of other health care services similar to the State of Oregon's plan a few years ago. From what I've observed, the insurance industry is very durable. It would take tremendous political will to change the system in the way Dr. Lundberg recommends.

Another key point Dr. Lundberg addresses is physicians' need to "take back" their profession. He maintains that the profession of medicine has devolved into the role of technician. Doctors are losing their autonomy and becoming corporate drones rather than the professional healers they intended to be.

I think it is possible that physicians may eventually just be specialists and cede primary care to nurses and allied health professionals in order to contain costs and maintain their professional (and income) status. (I believe that Nurse Practitioners can already write prescriptions in some states.) However, there would have to be many fewer physicians for this to happen.

Dr. Lundberg's comments about the pharmaceutical companies remind me of nine years ago when I worked in that industry. At that time, drug companies were making huge profits relative to other industries as they continue to do today. While drugs now make up a larger percentage of total health care costs than they did in 1992, the pharmaceutical companies were (and are still) one of the few bright spots in an otherwise uncertain economy. Given that fact, I wonder if the current administration would want to intervene.

Severed Trust was a good read. Dr. Lundberg covered timely issues from medical ethics and health care access to medicine on the Internet. The book provides a strong overview of the problems in the US health care system today and will hopefully help generate more efforts at serious reform.

While this book's solutions may seem dated following passage of the Affordable Care Act, how we got to this point is well written. It should be required reading for anyone considering leadership in healthcare, and anyone who works in the managed care. It gives necessary background to understand health policy. Lundberg did well presenting a complex situation in a politically open manner.

SEVERED TRUST is a critique of the U.S. medical systems.
The author laments the changes in the physician-patient relationship where it went from a more personal relationship with trust and decision-making to a commercial relationship.

He levels blame on many parts of the health care system and rightfully so. Some of the usual suspects are present- the insurance companies, pharmaceuticals, the government. We as patients and our physicians bear some of the responsibility as well.

I thought his assessment of health insurance companies on page 47 was accurate- " The health insurance industry represents another unnecessary administrative cost. All it does is collect money, keep as much as it can, and dole out as little as possible."

One of the provocative issues addressed in the book is the "heroic measures" that oppose a patients intentions in a living will.

Another area I found thought-provoking was the low number of autopsies performed after a patient dies in a hospital. He made a very good point why some hospitals and doctors don't want autopsies performed on their patients.

Overall a good book about a prominent, current, political issue.
As another reviewer pointed out, Dr. Lundberg does have a habit of repeating himself and it can be annoying.
SEVERED TRUST is still a book worth reading about health care.

I'm giving the book four stars just because it urges medical reforms in general. From a strictly objective viewpoint, it earns three stars. Lundberg's book is in some ways very similar to mine, but he rarely talks about what doctors do most: administer and prescribe drugs. I'm sure he knows how to reform the health-care system better than I do, but he should have elaborated more on fixing the medical errors that kill 40,000-100,000 American patients every year. If you want to read about a bunch of red tape strangling the medical establishment, then buy this book...

I was very interested in reading this book because of his background. And his history of how we have gotten to the state we have is fascinating.

But his solutions don't seem to be the answer either. But they are interesting. And maybe his GP emphasis sounds good in theory. I mean building relationships would help restore faith and trust if we can afford it. But his plan favors people paying for the general illnesses that take us to the doctor most frequently. Yes I agree we need to emphasize preventive and catastrophic care but to throw all the rest back on the people will lead to the same problem as the uninsured now --- people can't afford to go for care until they are so sick they don't have a choice.

And he doesn't address the OVER-PRESCIPTION of drugs to combat everything these days. My parents take dozens of pills a day between the two of them - that can't be good. He focuses on high end/cost tests like stress tests and MRIs etc...which don't affect as many people.

And boy does the man repeat himself in this book.

Its great info but preachy, non-practical and totally overemphasizes a doctor/patient relationship that isn't practical in this busy day and age.

American medicine was designed for corporate profit at the cost of 150,000 American lives from adverse drug reactions each year, and over 3.2 million hospital admissions from adverse drug reactions!Do you think it is time to re-evaluate the medical doctor's premise for the cause of illness?
The FDA is complicit when they allow drugs to be approved that have known serious side-effects that can cause liver and kidney toxicity and death. The emergency room and specific surgeries and some drugs are life saving and necessary, and really this is medicine's finest hour. Fortunately American's are finding out that most medical doctors never understand the actual causes of their patient's symptoms, and to make things worse, the drugs given to treat these symptoms actually worsen the patient's problem by affecting the G.I. tract ecology and the ability of the liver to detoxify toxins from the environment. So called "alternative treatment" in the US is actually "treatment of choice" for the rest of the world. Acupuncture, herbs, diet changes, nutritional supplements all allow the body to heal itself even with the exvironmental and emotional stress we are all exposed to.
This book is a very important addition to the volumes of information currently available about the changing perspectives on the American healthcare system.
Corporate profit will always be at the core of our Earth's problems, because drug companies and oil companies are not concerned with health or the environment. Medicine is a religion, not a science as is claimed, and as more American's are beginning to figure this out, our approach to illness will change!
Read this book and get a lesson from a man that understands!

I purchased Severed Trust with great expectations. Upon completion I can only say that the author is part of the problem. The book's advice and tone is pompous and arrogant at best. Misleading and misguided are also applicable adjectives.

The twin pillars Lundenberg advocates for MDs to regain the trust and confidence of the American public are limiting access to the health-care system and limiting organ transplants to one per patient.

Lundenberg fails to address the important health-care choices facing the public, including nutrition, diet, alternative treatments, and ever-increasing costs.

The book is written by an MD so close to the problems he cannot or will not honestly critique his profession.

Lundenberg's work is an insider's view of his own navel. It reads like a public relations piece rather than insightful examination of the issues and potential solutions in the public and private health-care arenas.