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When a pound of cure is too much

Another phase of the US healthcare crisis: patients who are overtreated.

By / January 2, 2008

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer By Shannon Brownlee Bloomsbury 320 pp., $25.95

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Most Americans know that the healthcare crisis in the United States is a two-headed monster: First, medical care is too expensive. And, largely because it's so expensive, that care doesn't reach millions of people who are poor or uninsured.

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But what few may realize is that the crisis has an ugly third face: Many Americans receive too much medical care. Those excess pills, heart stents, MRIs, radical mastectomies, and other treatments not only are often ineffective and waste hundreds of billions of dollars, they also sometimes harm the patients they are intending to help.

That's the fascinating, counter­intuitive, and potentially revolutionary conclusion of award-winning science journalist Shannon Brownlee in Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. A reader is likely to come away agreeing with Brownlee that reform of the $2.1 trillion American healthcare industry – already the size of the entire economy of Italy and rapidly growing – will never happen unless some uncomfortable truths are confronted.

Among them:

•A shockingly tiny proportion of medical treatments and drugs have strong scientific evidence of effectiveness to back them up. Dr. David Eddy, a heart surgeon and healthcare economist, estimates "that as little as 15 percent of what doctors do is backed up by valid evidence." The prestigious Institute of Medicine, Brownlee adds, "estimates that only 4 percent of treatments and tests are backed up by strong scientific evidence; more than half have very weak evidence or none."

•The amount and type of "care a person receives depends less on what kind of care he needs and more on where he happens to live." That conclusion has been documented in decades of groundbreaking statistical research conducted by Dr. John Wennberg at Dartmouth Medical School and others. It shows that individual doctors take highly varied approaches to treating diseases based more on hunches than solid research.

•Despite Americans' eagerness to gain access to specialists, "the more specialists involved in your health, the more likely it is that you will suffer from a medical error, that you will be given care you don't need and be harmed by it."

•Unlike in other industries, the introduction of new technologies into medicine usually doesn't bring costs down, but boosts them.

The bottom line? Americans spend between one-fifth and one-third of their healthcare dollars – $500 billion to $700 billion – on medical care "that does nothing to improve our health," Brownlee concludes.

Brownlee, a former US News & World Report health reporter, has won several prestigious journalism awards, including the 2004 Association of Health Care Journalists Award for Excellence in Health Care Journalism and the Victor Cohn Prize for Excellence in Medical Science Reporting. In "Overtreated," which New York Times economic columnist David Leonhardt recently called the best economics book of 2007, she takes a cleareyed look at some baffling questions.

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