Reviewed by Kathy London

This book by Sharon Brownee documents a frightening and infuriating American health care system. “Politicians are constantly telling us we have the best health care in the world, but that’s simply not the case. By every conceivable measure, the health of Americans lags … other developed countries.” Using both individual stories and formal studies, Brownlee shows that a third of what we spend on health care is not only wasted, it is making us sicker. Money is certainly an issue, but the suffering of patients is more striking to me.

Our current, technology-based system is a modern invention, arising after World War II. Hospitals became “factories whose products were miracles.” I include this quote because most of the book makes me want to hide from hospitals. Unneeded diagnostics and treatments expose patients to all the risks of medical care (Brownlee presents many) without the benefits. Brownlee details the “desperate need in medicine for clearer standards and better evidence of what works” and the need to end a warped financial system that “propels clinical decisions.”

Brownlee presents many stories of injured patients and of doctors who are “absolutely gob-smacked” when presented with proof of overtreatment. For example, two cardiologists brought sophisticated heart procedures to a rural hospital in California. Some local doctors felt they performed excessive procedures. Healthy patients with minor complaints were coming out disabled or dead. Brownlee follows one doctor through his decade-long effort to get someone to act: Medicare, the State, anyone. Finally the FBI investigated and their outside experts estimated half the procedures were “inappropriate”. The hospital paid a large Medicare fraud settlement, and the doctors lost their licenses. What was striking to me was the sincere shock of the errant doctors. One doctor “appeared genuinely devastated by the charges…. He wept…”

Brownlee claims that “even bypass surgery offers a reduction in the chances of dying for only a tiny minority of patients… [while] 45 percent suffer from cognitive deficits like memory loss, confusion, or depression.” This section chilled me. My father suffered all these side effects after his bypass surgery. He once related that doctors told him he’d be healthy again but that didn’t come true. My father’s words are echoed by Brownlee: “The healthy, active [bypass] post surgery patient is an urban legend.” Did doctors ruin the last decade of my father’s life? I’ll never know.

The tale of high-dose chemotherapy with bone marrow transplant to treat advanced breast cancer is horrible. Tens of thousands of women underwent the brutally painful procedures from 1981 to 1999, and the nation spent billions of dollars, before properly performed, randomized trials proved it offered no advantage over the standard treatment. One doctor is quoted as saying “We believed in it so passionately. Now I think about all the women who died… who would have lived much longer without it.”

At whatever point in the book you become despondent, as I did, skip to the last chapter. After a few unnecessary pages imagining a utopian health care system, Brownlee tells us there are places in America that efficiently deliver excellent care. The Mayo Clinic, Kaiser Permanente, and Group Health of Puget Sound are widely known. But the best example and biggest surprise is the Veterans Health Administration (which is distinct from Walter-Reed and the army’s medical system). In the early 1990s, the VA deserved its terrible reputation. By 2003 the VA had outpaced the rest of the nation in nearly every measure of quality health care. This result came from a system that truly is socialized medicine (government owns the hospitals and employs the medical staff). Brownlee explains how the dramatic turn-around was accomplished. Some of the VA’s improvements sound like elements of the Affordable Care Act (“Obamacare”). I sure hope so!

Whatever your hopes and fears for the national health care system, read the “afterword” for tips on obtaining the best health care, and avoiding the worst, for yourself and your family. Brownlee offers questions you should ask and an on-line resource. She suggests you find a primary care doctor who communicates well; look for “patient decision aids”; if you have a chronic condition, ask your doctor how to avoid a crisis and resulting hospitalization. Read the book for more tips and don’t despair. Try to remember the earlier quote, that our hospitals became “factories whose products were miracles.”

Note: Brownlee wrote her book during the 2008 election. She ends with this: “When the election is over, our politicians will eventually have to start discussing the rising cost of medicine, and if they are honest with us, they will address the problem of unnecessary care.”

PS: Cancer screening doesn’t always reduce death rates, partly because of the erroneous notion that all cancers proceed quickly to death. http://fivethirtyeight.com/features/the-case-against-early-cancer-detection/