Mrs. Treppen had an entourage of specialists: a cardiologist, a gastroenterologist, a pulmonologist, a dermatologist, an urologist, an orthopedic surgeon, a gynecologist, and a neurologist. With all those doctors, she had every part of her body covered. I was her internist, and for her my role was not to provide care but to act as a traffic cop, directing her to the appropriate specialist.
Her medical care was disjointed; it was difficult for each doctor to keep track of what the other doctors were doing. So when her urologist gave her an antibiotic that interacted with the blood thinner that the cardiologist had prescribed, it was hard to place the blame on anyone. Fortunately, when she started to pass blood in her stool and went to her gastroenterologist, he realized what happened and stopped the blood thinners, avoiding a potentially fatal drug interaction. Of course, he also scheduled her for an endoscopy and colonoscopy, two costly and unnecessary tests. Mrs. Treppen suffered from a common American problem--an over abundance of specialists which produce worse, and more costly care.
American health care is failing, suffering with problems that jeopardize our well-being and that worsen each day. Science, tempered by compassion, once controlled medical decisions--but no longer. Today, the decisions doctor's make are governed by insurance reimbursement, consumer demand, liability concerns, and market share. Big business and money have come to dominate the American medical landscape. The choice of the antibiotics given for infections, surgeries performed for ailing hearts, chemotherapy administered for cancer, and screening tests recommended to prevent diseases are as strongly influenced by nonmedical, economic forces as by science or common sense.
Unfortunately, the performance of American medicine reflects the way decisions are made. When the medical care in the U.S. is compared to that of other industrialized nations, the care we provide is consistently among the lowest. Of the thirty nations that make up the Organization for Economic Cooperation and Development (OECD), the U.S. ranks near the bottom on most standard measures of health care. Another study, published in 2008, showed that the U.S. had "among the highest death rates from causes amenable to health care" In fact, the only aspect of health care in which the U.S. constantly ranks the highest in every study is cost. One result of that high cost is that more than forty-seven million Americans cannot afford medical insurance and one hundred million more are underinsured.
As Dr. Steven Wolf noted in the Journal of the American Medical Association, "One reason for the enormous health budget is that society overspends on unnecessary tests and treatments, many of which lack evidence of effectiveness and some of which induce net harm".
An entrepreneurial and overly specialized medical establishment dominates our health care system. Advocacy groups that see only one disease but are blind to the larger picture influence standards of care. A litigious and demanding public, which craves the newest and most expensive, drives cost higher and quality lower. Too Much Medicine illustrates with example after example the perverse economic incentives for health providers that leads to excessive waste, unnecessary testing, high prices, and harmful practices.
The book addresses how the pharmaceutical industry has successfully transformed common human conditions into diseases in order to create new markets for expensive medications. These drugs--such as those for erectile dysfunction, baldness, and overactive bladder--are boldly advertised on television and in magazines, complete with celebrity endorsements.
Such business methods have made pharmaceuticals one of the most successful and lucrative sectors in the U.S. economy with profits well out of proportion to the only modest improvement they have produced for American health.
American medicine is excessive; millions of needless Pap smears are done in the U.S. annually, half of cancer treatments are inappropriate and unnecessarily dangerous, much of our surgery is unnecessary, and unwarranted x-ray testing is done in spite of its well recognized danger. Even dying in America is impacted by business concerns.
When Americans are questioned, most express dissatisfaction with our health care and that dissatisfaction grows each year. In November 2007, 81% of Americans surveyed expressed dissatisfaction with the U.S. health care system. In face of seemingly overwhelming problems, a cure for our ailing system might seem hopeless. Certainly the government time and again has found itself ineffective in protecting the public against the pressures from doctors, hospitals, and advocacy groups, and has often contributed to the excesses through politically motivated legislation. Answers do exist, but only if and when the problems are correctly identified.
In spite of American medicine's deeply rooted problems, it has been responsible for medical progress unsurpassed in history. As a member of our health care system for over twenty years, I am concerned about the problems as well as proud of the advances. By creating a knowledgeable public that understands what constitutes good medicine and what factors control modern medical decisions, I hope that Too Much Medicine will be a step towards providing the best care possible for all Americans and ultimately towards healing our damaged medical system while a cure is still attainable.