More Harm than Good | Necessary and Unnecessary Medical Treatment and Procedures

If you are over sixty-five, you many not want to delve into More Harm Than Good. Hell, if you are over twenty-five, you may want to avoid it completely. Some of the revelations:

The "expiration date" for the body of a human being is between forty-five and fifty years;
The best and simplest follow-up medicine for heart-attack victims is aspirin, but less than half of all hospitals ---including university hospitals --- offer this to departing patients;
Practicing doctors and nurses rarely get flu shots. Seventy percent of those most able to infect the rest of us don't bother;
Wealthier people in America may receive worse healthcare than those on Medicare or the very poor;
Avoid "stress tests" for possible heart problems --- the test itself may give you heart problems;
The best treatment for prostate cancer may be no treatment at all;
Ditto for stents;
Ditto for back surgery to relieve pain;
Ditto for calcium build-up in the arteries. This last is often treated by cardiac catheterization which may create a further build-up of calcium.

Many of the facts in More Harm than Good come from "The Dartmouth Study." This semi-official document analyzed "variations in medical practice reviews" using the Medicare database. It zeroed in on variations in medical practice, "how likely is it that a given medical procedure will be used for a certain medical condition in different communities."

It then considers the outcome a measure of "the quality of life and quantity of additional life." And, finally, it tried to examine what causes the variations in these two.

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More Harm than Good is a discouraging book. Our zillions of dollars invested in medicine and medical care are no longer paying off. Those with higher incomes, who should have the best healthcare of all in America, suffer from a proliferation of specialists who --- more often than not --- do not communicate with each other;

In the cases where the most money and the most care were lavished on the luckier (or at least wealthier) patients, the outcomes were slightly worse than in the poorer areas: specifically the survival rate of the patients was actually slightly lower in the areas where the most money was spent.

The book hit home with this particular reader. Not long ago, after I suffered from an "atrial flutter," my coronary doctor recommended a stress test. Since I cannot run on a treadmill, she told me it would involve injecting me with something that would artificially subject my heart to stress. I regretfully declined, told her just being in her office was all the stress I needed.

Later, I ran across this passage:

One of the most common secondary tests is a so-called coronary "arteriogram," which has a degree of mortality in and of itself. That is, there's a small but measurable chance that the test itself can kill you.

Other surprises:

--- The best oral treatment for diabetes was discovered in 1918; it is known as Matformin;

--- Most degenerative diseases (Alzheimer's, osteoporosis) are coming to be seen as problems in the immune system, largely based on basic research on AIDS. (The chapter on the genesis and gradual subduing of AIDS is, alone, worth the price of the book);

--- Brush and floss every day. I kid you not: people with the worst teeth have a higher risk of strokes and heart attacks;

--- Despite all its scandals, the best long-term medical care in America comes from the Veteran's Administration Hospitals. These represent, of course, America's first venture into socialized medicine, something no administration would ever admit. The authors state, baldly, that VA expertise has made it possible to prevent many

medical errors such as "wrong side" operations, incorrect dosing of potentially dangerous medications and other avoidable errors that result in more than 100,000 deaths per year in community, academic and specialty hospitals outside of the VA system.

As I recently wrote to a good friend of mine, "If you are planning to get old, it is worth your while getting and reading More Harm than Good."

--- Charles Wendell Walker