- Paperback: 272 pages
- Publisher: Scribner; Reprint edition (September 15, 2009)
- Language: English
- ISBN-10: 1416551549
- ISBN-13: 978-1416551546
- Product Dimensions: 5.5 x 0.7 x 8.4 inches
- Shipping Weight: 14.7 ounces (View shipping rates and policies)
- Average Customer Review: 60 customer reviews
- Amazon Best Sellers Rank: #248,074 in Books (See Top 100 in Books)
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Hippocrates' Shadow Reprint Edition
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"In Hippocrates' Shadow, Dr. Newman sits us down for the doctor-patient chat we've been longing for -- a refreshingly candid, daringly inquisitive discussion of the uneasiness that exists on both sides of the medical care equation these days. There is a cure for what ails us, and Newman doses it in thoughtful, perceptive proposals that make good sense. In the end, everyone feels a whole lot better. There is hope." -- Amy Silverstein, author of Sick Girl
"There are few books that I really almost cannot put down, but Hippocrates' Shadow is one. A stunning indictment of current medical practice by a hard-headed doc tested in big-city emergency rooms, combat hospitals in Iraq, and at his mom's bedside. If your doctor is this frank with you, you are a very lucky patient, and you are getting a lot better (and sometimes a lot less) treatment than most." -- Melvin Konner, MD, PhD, author of Becoming a Doctor
"Dr. Newman's book is insightful and thought provoking. He teaches the reader about aspects of medicine that many of us, lay people as well as physicians, do not understand or appreciate, including the imperfection of the 'science' of medicine as well as the progressive loss of the 'art of medicine.' Anyone who wishes to better understand the promise and limitations of medicine should read this book." -- Geoffrey Kurland, M.D., author of My Own Medicine: A Doctor's Life as a Patient
"A clear-sighted, heartfelt, and humane story of the needless tests and treatments that cripple health care -- and how to get rid of them. As a guide to good medicine, it may help us get back to the essence of what good doctors do: be with patients in healing." -- Samuel Shem, M.D., author of The House of God, Mount Misery, and The Spirit of the Place
About the Author
David H. Newman, M.D., runs a clinical research program and teaches at Columbia University and in the Department of Emergency Medicine at St. Luke’s/Roosevelt Hospital Center. He has also been widely published in biomedical journals. In 2005, as a Major in the Army Reserves, he was deployed to Iraq, where he received an Army Commendation Medal. He lives in New York City.
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The following are my notes on key points from the book:
(1) The rise of science and technology in medicine, though beneficial in many respects, has resulted in narrow specialization, as well as costly and sometimes misleading overuse of testing. Indeed, many doctors and patients have forgotten that medicine is about health outcomes, not "science." A general result is that doctors often no longer treat whole patients, so communication between doctors and patients has greatly suffered. This is especially unfortunate because the quality of doctor-patient communication has been found to be a significant factor in patient outcomes for a variety of medical conditions. In fact, such communication is a contributor to placebo effects, which are biologically real and are related to the ways in which the mind ascribes meaning.
(2) Medical knowledge is still quite limited in many areas, and the more we know, the more we find out we don't know. Medical "facts" are thus tentative understandings which often need to be revised or discarded, sometimes within a decade or so after becoming widely accepted. Disagreement among doctors regarding diagnosis and treatment is an indication of the limitations of medical knowledge. Moreover, the paradigm of modern medicine generally includes many fallacies, ineffective treatments, and poor practices which remain entrenched for a long time even in the face of abundant contrary evidence. In the same vein, different medical specialties and institutions often have different practices for treatment of even the same conditions. And yet doctors often hide their ignorance and patients often incorrectly presume that medical knowledge is complete. One result is that "where alternative and complementary medicine has flourished, it's nearly always a sign of modern allopathic medicine's failure ..."
(3) The overall effectiveness of particular medical treatments varies from very high to zero, depending on the medical condition. This effectiveness can usefully be quantified by measuring the number of patients which need to be treated in order for a single patient to benefit from a particular treatment (NNT). The NNT thus varies from one (always effective) to infinity (never effective). However, it must be remembered that the NNT is a statistical measure applicable to populations, and thus doesn't specifically predict how an individual patient will respond to a treatment. Also, any potential benefits of treatments must also be weighed against potential adverse effects, especially considering that roughly 100,000 people die each year in the US due to medical error.
(4) Health care spending per capita in the US is, by far, more than any other country, yet US health care outcomes are near the bottom among industrialized countries in nearly every category. In particular, "... health-care spending in the final year of life (and predominantly in the final one to two months of life) now represents nearly a third of our system's total health expenditures." Part of the problem is that our system is biased towards generating profits, rather than solely focused on (cost-effectively) improving health outcomes, and it's noteworthy that research funded by pharmaceutical companies has (unsurprisingly) been found to be biased. Also, behavioral issues such as alcohol misuse, smoking, poor diet, and physical inactivity account for about 40% of annual US mortality.
One area where I somewhat disagree with Newman is in relating the Heisenberg uncertainty principle and Godel's theorems to medical practice. Both of these have precise technical meanings which don't have much relevance to medicine, so these are at most metaphors, and possibly misleading as metaphors.
But overall, other than the exception noted above, I think this is an excellent and eye-opening book, and I recommend it to anyone who wants to realistically understand medical practice and how to more effectively utilize the services of doctors. And indeed several doctors have reviewed the book and indicated that they learned a lot from it, so I suppose the book can be recommended to doctors also.
As further reading, I suggest the following, in order of increasing sophistication:
How Doctors Think by Jerome Groopman
How Doctors Think: Clinical Judgment and the Practice of Medicine by Kathryn Montgomery
The Logic of Medicine by Edmond Murphy
The book is scattered with excellently researched and referenced examples of medical practices that are conducted mindlessly by some of the brightest minds in our society. These include not using epinephrine for digital surgery and antibiotics for strep throat. It gave me pause to consider all the things I take for granted and question them rigorously. Dr. Newman has changed my life; this is no hyperbolic statement. I heard him speak once and he was a tremendously engaging speaker with a very New-York style humour; his wit is evident in his prose as well.
In summary, a highly enjoyable and conversationally written book that will spur you to examine the evidence behind your medical practice.