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Product details
File Size: 1181 KB
Print Length: 267 pages
Publisher: The University of North Carolina Press; Reprint edition (September 12, 2011)
Publication Date: September 12, 2011
Sold by: Amazon Digital Services LLC
Language: English
ASIN: B005NP78I4
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This is the author's third book investigating medicine shortcomings. The first two were: The Last Well Person: How to Stay Well Despite the Health-Care System and Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman). They are all excellent. Hadler has extensive firsthand experience as a doctor, a med school professor, a clinician, and a medical investigator. Thus, he is well equipped to evaluate what works and what does not in modern medicine.Hadler's main beef is that U.S. health care "medicalizes" normal conditions by undertaking treatments and prescribing drugs that are costly, do not work well and have side effects. He calls such malpractice a Type II error (doing something that is unecessary that may cause harm). Hadler supports his assertions by referring to numerous studies.Medicalization becomes increasingly costly to the patient and taxpayers (and lucrative for the medical complex) as we age. A large percentage of health care dollars are spent on patients' last year of life. And, those expensive procedures are of no benefit to the elderly in terms of quality of life and lifespan. This book is interesting as it focuses primarily on the medicalization of the aging population. Meanwhile, the first two books looked at the overall medicalization phenomenon.Hadler, more than in his other two books, uncovers the relationship between socioeconomic status and health. Referring to a study of 10,000 British civil service individuals, he shares that the major determinant of lifespan was one's position on the socioeconomic gradient. Health adverse behaviors and cardiovascular risk account for only 25% of mortal hazard. In Chapter 4 The Aged Worker he explores this issue further. Individuals happily employed fare better health wise than others. Those health benefits carry into retirement. He calls this theme "social capital."The relationship between weight and lifespan is unexpected. Three studies from Australia, Canada, and the US. confirm that health and lifespan outcomes are not materially different for BMI ranging from 22 to 30. Thus, Hadler feels we spend too much time worrying about our weight. He personally does not know how much he weights. If one wants to lose a bit of weight, he recommends simply eating less as he acknowledges we are conditioned to overeat in a supersizing society.Regarding cardiovascular disease (CVD), Hadler, just like Uffe Ravnskov (check out his excellent The Cholesterol Myths: Exposing the Fallacy That Saturated Fat and Cholesterol Cause Heart Disease), reveals that cholesterol and saturated fat risks of CVD are not on strong scientific footing. Thus, both cholesterol and saturated fat are not bad for you. Statin drugs have a bad trade off as they have little effect on reducing CVD events and may cause serious side effects including muscle impairment, kidney disease, and higher incidence of diabetes. Hadler is also skeptical of the most recent CVD risk factor: C-reactive protein. The science is not convincing.Cholesterol and diabetes prescription drugs for the elderly are huge businesses. None has been shown to make a material clinical difference in reducing related diseases incidents and improving longevity. He feels little lifestyle modifications are more effective without negative side effects.Hadler notes that authors of medical studies with financial ties to the supplier of the health product they test are several times more likely to write a positive review than other investigators with no related financial ties.Hadler indicates that treating what appears like high blood sugar, high cholesterol, high blood pressure (Systolic 140) in otherwise healthy older patients is not beneficial. All those markers increase with age. The revised threshold for hypertension (140/90) are too low. He states: "by this definition, more than 90% of people who have a normal blood pressure at age 55 will develop hypertension as they age." This is medicalization.In terms of CVD treatments, he considers both preventive bypass surgery and angioplasty to be a travesty. "The benefit/risk ratio of bypass surgery and angioplasty is zero since we can't demonstrate any benefit. There is a tiny subset with a particular blockage that might be benefited by bypass surgery (about 2% of the patient with left blockage)." He refers to five studies who demonstrate no benefit for either of those procedures resulting in no fewer cardiovascular events or deaths (pg. 51-52). Considering the costs of such procedures, he states on page 54: "We are mortgaging our country to support an industry that scorns scientific rigor. That's irrational."Regarding screening for breast cancer with mammography, he indicates there are no benefits to undergo this test for women under 50 or over 70. And, for women within this age range the benefits are marginal. In table 3, page 67, he shows that based on an extensive study related to women in their fifties undergoing mammography every one to two years for ten years the probability of dying from breast cancer was hardly lower vs women not screened (0.46% vs 0.53%). Yet, the probability of false positives requiring unnecessary biopsies and further invasive intervention was up to 20%.Screening for prostate cancer is an even more egregious medicalization. Some presence of prostate cancer is normal in older men. He states on page 75: "By age sixty, every man should assume he has [some] prostate cancer... nearly all men die with prostate cancer but very few from prostate cancer... Of those who die from prostate cancer, most would have died about the same time from something else (usually heart disease)." Digital rectal exam and PSA test are highly inaccurate, resulting in a majority of false positives. Even when they do detect prostate cancer in the majority of cases it would not have lifespan implications. And, the most common procedure to treat this cancer (removing the prostate) results in frequent chronic impotence and incontinence.Regarding colon cancer screening, he recommends individuals undertake a sigmoidoscopy just once, if at all, that examines the lower intestine where cancer is most frequent. Undergoing colonoscopy is associated with a non negligible risk of intestine perforation (about 0.2% per procedure). Sigmoidoscopy is much safer.When he moves on to osteoporosis and osteopia, he indicates that our focus on bone mineral density (BMD) has little predictive power regarding probability of bone fractures. He states on pg. 130: "I see no [evidence based] reason for any well woman to submit for BMD at any age." Our focus to boost BMD through prescription drugs, calcium, and vitamin D has not demonstrated convincing results. He feels we get enough calcium and vitamin D in our diet as both are added to dairy products. Also, vitamin D that is not activated like the one we get from sun exposure does not do that much.Hadler is skeptical of many orthopedic surgeries. On pg. 139 he adds: "elective orthopedics is coauthoring the bleakest chapter in the history of Western medicine with the interventional cardiologists." He indicates that total knee replacement surgeries have had dismal results. Studies on arthroscopic knee surgeries have demonstrated they do not work. However, his assessment about hip replacement is much more positive.Many prescription drugs do not work that well. But, their results are often much worse for the elderly that are often more susceptible to their side effects and reap fewer of their benefits. Antidepressants have unfavorable benefit-risk trade offs for the elderly. Meanwhile, Aricept show no benefit over a placebo in the likelihood of progression Alzheimer's and Dementia.In one of the last chapters, Hadler teaches us how to live and die well. In one's ninth decade (80+), both the quality of living and the quality of dying should be primarily health concerns. This means passing away at home in a loving environment surrounded by relatives and specialized nurses providing comforting palliative care. Instead, elderly often die alone, anxious, without dignity while being overtreated and overdrugged in a hospital.As we age into our seventies and beyond, we all have some latent cardiovascular and cancer issues. Yet, Hadler says on pg. 175: "It makes no sense to cure the disease one will die with, in the ninth decade and little sense to cure the disease that one will die from in the ninth decade if another is to take its place in short order."
My 89 year old mother had a stroke in April. Due to her advanced age and increasing health problems I thought after the stroke she should receive palliative care till she died. I was almost shocked to experience the exact opposite from the health care system. She was provided, with little discussion with her family, the most expensive testing and life saving treatment available. Since she was a big believer in our wonderful health care system she visited her doctors frequently prior to the stroke and followed all their advice which included taking at least 7 pharmaceutical drug and many vitamins. After her stroke she left the hospital on 10 different medications. The health care system insisted that she also needed rehab and could have the potential to live independently again. After grabbing $100,0000 in medicare dollars for acute care and rehab services there is no money left to actually care for my mother. Unfortunately she needs 24 hour care and her mind is no longer rational. This job falls to the family and is an extreme hardship emotionally as well as financially. I am writing this to preface where I personally was when I read this book. Reading it was like seeing the sunshine after a long time in the dark. The book looks at the over treating of the natural aging processes and the reasons behind our health care system big push to treat most health matters with medication. The time with any health care professional is very limited as they are forced to see a higher patient volume and in many systems are only allowed 10 minutes or less with a patient and in which charting is also included. Very little healing can be done in this type of system other then writing a prescription. The other surprising information is the scientific data to support many of these pharmaceutical treatments is just not there yet the statistic are reported on in such a way to make the lay person believe the expensive medications are not only helpful but vital to their ongoing health. In most cases the studies if looked at statistically are not that convincing. Most of the health care professionals that I have run into these past 6 months were very well meaning. Unfortunately some of them like her cardiologist were defensive and negative when I asked to have some of her medication stopped. I believed they were causing some side effects and I doubted they would help the quality of her life at this time. I did stop these medications with no change in my mother's BP, nor has she had the atrial fib they promised she would get after stopping her medication. The book would be helpful to anyone entering their 60's and beyond so that each of us can make informed decisions about our health and how we will deal with the aging process. Health care it seems needs to move beyond an authoritarian system where we all should "obey doctors orders" and continue to move towards an informed consent model where ones health care provider has the time to review treatment options with their patients including no treatment. I thank Dr Hadler for thinking outside the box and exposing a system that needs revamping especially when caring for our aging population.
This could be Holy Grail for the elderly if they would just stop thinking there is a pill for everything and waking up every morning asking themselves, "Where do I hurt today?"Dr. Hadler could be a motivational speaker for old folks if they would only listen! Sadly, he makes too much sense, Evahbody wants to go to Heaven, but nobody wants to die. And our prescription drug society is going to see to it that we linger forever in a dismal rest home, or if we are "luckier" - the Senility Hilton.I will be 87 next month and have "looked at life from both sides now", and it will never be through a haze of pills with the label "May cause dizziness, light-headedness, drowsiness....." Mercy! Elderly take all that and then wonder why they fall and break a hip. Not me!
I first read this book from my local library and found such good information in it that I bought it for my own reference. The book is written by a doctor with many years of experience and vast knowledge of medical studies. It warns of the current practice in America of over-treatment and over-medication of older people. Everyone over 65 should read this book!
A brilliant book and a must read for anyone at any age, especially those over 50. Have shared and recommended this book to everyone I know.If there is one book you should read, this is it.Dr. Hadler is an amazing writer and is clearly one of the preeminent thinkers of our time. If only there were more Dr. Hadler's in our world.You will not be disappointed and it will provide you with great insights for maintaining the quality of life we all desire.
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