Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) [Hardcover]

MD Nortin M. Hadler (Author)

Book Description

Publication Date: June 2, 2008 | ISBN-10: 0807831875 | ISBN-13: 978-0807831878 | Edition: 1

At a time when access to health care in the United States is being widely debated, Nortin Hadler argues that an even more important issue is being overlooked. Although necessary health care should be available to all who need it, he says, the current health-care debate assumes that everyone requires massive amounts of expensive care to stay healthy. Hadler urges that before we commit to paying for whatever pharmaceutical companies and the medical establishment tell us we need, American consumers need to adopt an attitude of skepticism and arm themselves with enough information to make some of their own decisions about what care is truly necessary.

Each chapter of Worried Sick is an object lesson regarding the uses and abuses of a particular type of treatment, such as mammography, colorectal screening, statin drugs, or coronary stents. For consumers and medical professionals interested in understanding the scientific basis for Hadler's arguments, each topical chapter has an accompanying source chapter in which Hadler discusses the medical literature and studies that inform his critique.

According to Hadler, a major stumbling block to rational health-care policy in the United States is contention over the very concept of what constitutes good health. By learning to distinguish good medical advice from persuasive medical marketing, consumers can make better decisions about their personal health and use that wisdom to inform their perspectives on health-policy issues.

Editorial Reviews

Review

"In Worried Sick, author Nortin M. Hadler, M.D., presents a carefully reasoned case to help health-care providers assess the value and benefit of potential therapies to better treat their patients."
-Los Altos Town Crier

"It is impossible to read this monograph and remain complacent with the current medical model. . . . [Hadler] very clearly states a series of provocative tenets which deserve serious consideration."
--The Pharos

"An important book. . . . The reader will understand symptoms and their causation and will be richer for it--intellectually and in pocket."
- Journal of Rheumatology

"To change unrealistic expectations about longevity or lives without pain or illness bucks vested interests, but that is what Hadler does. . . . He knows that the changes he proposes are a long shot, but when people demand that medicine stop doing unnecessary things well, reform becomes possible. Recommended."
- Choice

"[Hadler's] arguments are logical and make one think about the status quo."
- Milwaukee Academy of Medicine

"This is recommended reading even if you are determined in advance to despise it. You will be better off having wrestled with his arguments and . . . probably will not find them easy to refute."
- Journal of American Physicians and Surgeons

"[Hadler's] self-confessed 'diatribe against medicalisation' is an engaging read."
- Medical Journal of Australia

"Thought-provoking, and one of the better critical treatments of our health care approach."
- DTC Perspectives

"A seminal piece of medical literature with an Avicennian touch that will be read and debated by health care professionals for years to come."
- Wake County Physician

Case by case, drug by drug, test by test, and procedure by procedure, Hadler exposes the excesses, the unjustified costliness, and the ineffectiveness of the present medical scene. He presents a proposal for a health-care insurance system that will increase the health of the nation, provide only effective care, and reduce costs. All self-funded employers must read, absorb, and install Hadler's well-founded ideas.
- Clifton K. Meador, M.D., author of A Little Book of Doctors' Rules, Med School, and Symptoms of Unknown Origin

This book challenges readers to alter their notions about health maintenance, discarding beliefs about the efficacy of certain medications, screening tests, and procedures. . . . This thoughtful message from an experienced medical practitioner has merit and may convince the general public to advocate more forcefully for change.
- ForeWord Magazine

Challenging conventional medical wisdom, [Hadler] advises a healthy skepticism about the benefits of drugs, routine tests, and many common medical procedures. . . . The book . . . will educate [readers] on being far better health-care consumers. . . . [A] provocative look at the U.S. medical system.
- Library Journal

A serious diagnosis of what ails modern American medicine which will surprise and educate even the most savvy reader. Hadler exposes the fallacies that drive unnecessary and often harmful treatments and offers a hard-hitting series of remedies that could benefit us all.
- Jerome Groopman, M.D., Harvard Medical School, author of How Doctors Think

"Provides readers with the perspectives and skills necessary to advocate for themselves in the contemporary health care delivery system."
- Journal of Economic Literature

"[Hadler] has the requisite irreverence and skepticism toward medical providers and the healthcare labyrinth to write a clear-sighted appraisal of the current system's failures."
- The Morning News

"Having guidelines for reimbursement that went through a Hadlerian analysis is not a bad place to start reducing medical care costs without reducing the quality of patient outcomes. A much more politically attractive, and potentially quite effective, reform would make it routine for patients to be exposed to Hadler's kind of analyses whenever they are asked to consider any significant medical intervention."
- Journal of the American Medical Association

"Anyone who wants help in evaluating . . . treatments will welcome the details that Hadler provides. . . . [His] challenge to the value of these treatments demands a response from the physicians, pharmaceutical companies, and others who sell these treatments' benefits and urge us to 'take advantage' of them."
- Chapel Hill News

"Dr. Hadler . . . is a longtime debunker of much that the establishment holds dear. . . . Reviewing the data behind many of the widely endorsed medical truths of our day, he concludes that most come up too short on benefit and too high on risk to justify widespread credence. . . . Raise[s] serious questions."
- The New York Times

"The question Worried Sick: A Prescription for Health in an Overtreated America aims to answer is how to get your four score and five. Surprisingly, it argues against relying on many of the accepted practices of modern American medicine. . . . Iconoclastic."
- Raleigh News & Observer

"A withering critique. . . . [Hadler has] the knowledge, power, and moral obligation to reject the false coin of commerce and technological hype and to reassert the primacy of the patient."
- New England Journal of Medicine

About the Author

Nortin M. Hadler, M.D., is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill and is attending rheumatologist at UNC Hospitals. He is author or editor of numerous books, including The Last Well Person: How to Stay Well Despite the Health-Care System.

Product Details

• Hardcover: 392 pages
• Publisher: The University of North Carolina Press; 1 edition (June 2, 2008)
• Language: English
• ISBN-10: 0807831875
• ISBN-13: 978-0807831878
• Product Dimensions: 6.1 x 1.2 x 9.2 inches
• Shipping Weight: 1.5 pounds (View shipping rates and policies)
• Average Customer Review: 3.8 out of 5 stars  See all reviews (22 customer reviews)
• Amazon Best Sellers Rank: #78,994 in Books (See Top 100 in Books)
  • #36 in Books > Medical Books > Medicine > Doctor-Patient Relations
  • #65 in Books > Medical Books > Administration & Medicine Economics > Public Health > Epidemiology

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).

Most Helpful Customer Reviews

84 of 87 people found the following review helpful

5.0 out of 5 stars A MUST READ! April 30, 2008

By Fred Amir

Format:Hardcover|Amazon Verified Purchase

If you want to save yourself from being labeled with a disease you don't have and take medications you don't need, then you must read this book.

Worried Sick is a follow up to Dr. Hadler's The Last Well Person. It has updated research information and written for the public at large. In this book, Dr. Hadler examines many of the common diagnoses and treatments and questions their validity and scientific basis. He shows clearly that many of them are not founded based on science, and that treatments are of questionable value, and possibly harmful.

Here is a brief overview but you really need to read the book for the whole story.

1- Heart bypass surgery and angioplasty: Dr. Hadler explains how bypass surgery has not been shown to be of any use. In fact, some patients whose chests were simply opened and closed had similar improvements in their level of pain after the surgery. However, those who had the surgery experiencing dementia (40%) and difficulty returning back to their regular jobs. Although, the efficacy of this treatment has never been proven, it and angioplasty continues to account for 500,000 procedures a year in the US.

2- Type 2 diabetes: He mentions that increase blood glucose level is an expected part of aging, and the effort to regulate blood sugar with medication has shown no effect in terms of preventing damage to the eyes or kidneys or preventing heart disease or stroke. In fact, ten years of intensive therapy offered no real advantage to 1000 middle aged hyperglycemic (high blood glucose level) people. So, why would anyone want
to be on therapy and suffer the side effects of medications that have no real benefits? He says changes in diet, weight loss, and exercise have are a much better approach.... Also what is considered a high blood glucose level? Those levels are set by committees, not necessarily based on scientific medicine, but many times based on influence by pharmaceutical companies.

3. Hypertension: Dr. Hadler also points out that high blood pressure is another area where science has not proven that by lowering the mild high blood pressure one can really make a difference in preventing heart disease or damage to organs. He recommends for people who have diabetes and hypertension and are elderly to be treated, if regular exercise, weight loss, and diet modifications do not help. But, to be focused on keeping the blood pressure at 120/80 and getting medication to those who are 140/90 and higher, and who have no symptoms and are feeling well, is not supported by research. One thing research has shown is that a cheap first generation diuretic works just as well as the latest and very expensive anti-hypertension drugs.

4. Ruptured disc: He points out that the concept of ruptured disc as cause of back and leg pain was proposed some 70 years ago and should have remained there. There is no evidence that a ruptured disc causes any harm. All the spinal changes due to age detected in an MRI or CT scan are normal. Some 200 randomized studies clearly show that all the treatments ranging from spinal manipulation, shots, and surgeries are of no benefit. All studies have shown that patients who refused treatment recovered as well or better than those who were treated. He recommends taking Tylenol for the pain and discomfort and getting back into one's regular routine and job.

4. Knee and shoulder pain: he also points out that knee pain is of the same case. The current diagnoses, such as a torn meniscus or torn rotator cuff, and treatments are of no value, and perhaps the solution is to take some Tylenol fro the pain and keep going until the individual recovers, whether it's back or knee pain.

5. HRT therapy for post menopausal women: here is another area which is touted as a way of preventing heart disease and osteoporosis in women. He points out that not only this has failed, but the equipment they use for testing is not accurate most of the time, and that the medications used for it don't really work. Exercise is a better alternative. Also hip replacement surgery could easily be replaced with pinning the hip,
which is less costly with a faster recovery rate.

6- Cancer screening: Like Dr. Welch, author of Do I Need to Be Tested for Cancer, he too finds no scientific basis that screening well people for cancer has any benefit. He calls it, "looking for a very small needle in a big hay stack."

There is much more in the book that you need to read for yourself, and I highly recommend that you do. I used to trust my doctor and the medical system until I began to have back pain. Due to improper diagnoses and treatments I developed pain in my neck, legs, arms, hands, and became completely disabled. That's when I realized I needed to take charge of my own health. This is where physician and health educators like Dr. Hadler provide a great service. By the way, he is also a consultant to ABC News. You can watch his commentaries and read his writing at ABC News website. Read more ›

28 of 29 people found the following review helpful

4.0 out of 5 stars What's Up, Docs? September 26, 2008

By bronx book nerd VINE™ VOICE

Format:Hardcover

In Worried Sick, Dr. Nortin Hadler contends that many procedures like bypass surgery, stents, angioplasty, colonoscopy, mammography, prostate cancer and cholesterol screening, among others, ultimately do very little for the patient and a lot for the medical and pharmaceutical industry. He claims that the biggest predictor of health is socioeconomic status (SES), and not necessarily any of the indicators flushed out by screenings and diagnosis. He proposes a health insurance scheme based on proven effectiveness of procedures and pharmaceuticals, with medical care incorporating SES questions into the history and diagnosis. His contention is that we have "medicalized" conditions that have always been the bumps and bruises of life, with this medicalization resulting eventually in health insurance coverage and expansion of definitions that captures more people in these conditions and thereby expands the pool of patients.

Hadler has been making these points for some time in other works, and I think it's an important voice in the debate over health costs and medical insurance. Ultimately, Hadler claims that we should be debating not just about the efficiency of delivering health, for some the panacea for reducing its costs, but fundamentally the effectiveness of the care offered and provided. If, as Hadler claims, so many of the procedures, pharmaceuticals and gadgets foisted on the American public do little, nothing or may actually be harmful, why argue about how to better provide them, and instead, debate on whether they should be automatically included in the menu of options for which patients recruited and which insurance plans eventually pay....

My criticism of the book is that it is somewhat densely written, although Hadller's wit, sometimes expressed in sarcasm, probably evolved over time from the frustration of being a lone voice in the wilderness, makes the book more readable. However, a toned-down version could make the arguments moe accesible to the general public and perhaps give the book and its message a greater impact. Read more ›

13 of 13 people found the following review helpful

4.0 out of 5 stars Maybe this should be required reading for older people October 17, 2008

By Alison Ulrich

Format:Hardcover

An eye-opener for so many caught on the treadmill of tests, diagnoses, questionable treatment. There's a lot of commonsense dispensed in this book that makes me realize anew how much more frightening is morbidity than mortality.

10 of 10 people found the following review helpful

5.0 out of 5 stars Oh, so needed to be said!! May 1, 2009

By James A. Garfield

Format:Hardcover|Amazon Verified Purchase

As a physician, I have been waiting for decades to read such a book. The statistics make this a rather slow and difficult read, but it will be a live saver for many who "get" the message.
James A.Garfield, M.D.

10 of 10 people found the following review helpful

4.0 out of 5 stars MD's, PA's, NP's should read this book! January 18, 2009

By AvidReader

Format:Hardcover

While not the easiest book to read, Dr. Hadler's book is well worth the effort for all of you MD's, PA's, and NP's in the United States. It might well change your outlook on medicine significantly, ease some of the anxieties over the way you practice, and perhaps even ease personal/family medical anxieties. Bravo for Dr. Hadler, who has excellent medical credentials, for taking on the status quo in US medicine today. He convincingly explains why the US medical system is far from the best system, but far and away the costliest system. It's not just the fragmented system of greedy insurance companies -- it's the waste in doing a lot of medical treatments that are worthless or near worthless, and can, at worst, result in harm to patients. What happened to Primum non Nocere (first, do no harm) in medicine today? Thank you, Dr. Hadler. Read this book, medical providers!

13 of 14 people found the following review helpful

4.0 out of 5 stars Well worth reading ... October 31, 2008

By Curious Cat

Format:Hardcover

.. though not the classic his "The Last Well Person" is. This book restates and updates much of the information in "Last Well Person" as well as adding new information, but there is an undertone of frustration in it which I didn't find in the first one. I think banging his head against the brick wall of the American system of health care for the last 10-15 years has understandably caused Dr. Hadler some pain, and it sometimes shows. Also, the verbiage is occasionally unnecessarily dense, showing his years of arguing these points with health-care insiders rather than laymen.

This is nonetheless a very interesting book with well-supported positions and a wealth of information on what you need to know in evaluating "recommendations" by health professionals. The last section is Dr. Hadler's proposal for creating a sustainable health care system on the bones of the old system, rather than starting from scratch, and I found that very intriguing. I wish it had been fleshed out more, but it certainly creates a very good starting point for discussions.

In sum, I recommend this book for anyone interested in how we can make informed choices for our own health care and for the health care system in this country.