THE TREATMENT TRAP
How the Overuse of Medical Care Is Wrecking Your Health and WhatYou Can Do to Prevent It
By Rosemary Gibson
and Janardan Prad Singh
Ivan R. Dee, 237 pages, $24.95
Amid all the cheering and jeering over the health-reformlegislation recently signed into law, there remains one sober factabout our medical system that every American ignores at his or herperil: Contact with the health-care system remains one of theleading causes of death in the United States. The most recentconfirmation comes from a new study from the independent ratingscompany Health Grades, which found that between 2006 and 2008,nearly 100,000 Medicare patients died due to medical errors.
With tens of millions of currently uninsured Americans nowpromised greater access to care, the urgency of reforming thepractice of medicine, as opposed to its financing, has never beengreater. This makes the two books reviewed here particularlyrelevant, whether you are an individual trying to navigate thoughthe increasingly dangerous and dysfunctional health-care deliverysystem or a policymaker trying to figure out what's gone wrong andhow to fix it.
'The Treatment Trap' is co-authored by Rosemary Gibson, who longworked at the Robert Wood Johnson Foundation on health-care qualityand safety issues, and by Janardan Prad Singh, an economist at theWorld Bank whose previous work has concentrated on the same area.Together, they have produced a well-told, well-researched catalog ofhorrors about people killed and maimed by tests and operations theydidn't need.
Theirs is not the first popular account of the dangers of over-treatment, but it updates a story that cannot be told often enough,and in a way that can serve as a useful consumer guide to anyonecontemplating a course of treatment. Good to know, for example, thatone-third of all heart bypass surgeries are unnecessary or thatthere is virtually no evidence to support surgery for back pain.The authors are particularly effective in pointing out that muchgoing on in the name of prevention and diagnosis is wasteful orharmful. For example, they cite a study that found that undergoing afull-body CT scan exposes a patient to a dose of radiationcomparable to that experienced by some of the survivors ofHiroshima, yet has little proven value. Millions of women who haveundergone hysterectomies (a vastly overused procedure itself) aregiven Pap smears to test for cervical cancer, even though they nolonger have a cervix.
Reading 'The Treatment Trap' will set you up well for the subjectof Thomas Goetz's 'The Decision Tree': how to use a health-caresystem in which it is impossible to know whom to trust. Goetz is alongtime editor at Wired magazine, which means he knows how to writeand has a deep regard for the Internet and other informationtechnologies. And he holds a master's in public health from theUniversity of California at Berkeley, which means he's on top of themountain of new research showing the great disparities in howdoctors in different parts of the country treat the same diseases.
These different facets of his background come together in aspecific idea of 21st-century medicine. In this vision, patientsuse comparatively low-tech devices such as smartphones to collect data about themselves, such as blood pressure, glucose levels, howmany steps they walk in a day, etc. They use those data as apsychological spur to adopting more-healthful lifestyles and bettermanagement of any chronic conditions they might have. And, moreradically, they share much of this information on Web sites such asPatientslikeme.com, where people dealing with similar health issuescan compare outcomes while creating a database that researchers canuse to figure out what works and what doesn't in health care.
Goetz foresees a world in which individuals are much more attunedto the power of social networks to help them with their healthproblems and to process large flows of medical data in ways thatadvance science. It's a vision that will probably alarm many olderAmericans concerned with medical privacy and paranoid about anypotential breach. But for members of the Facebook generation, it'slikely to make perfect intuitive sense.
The secrets we keep in health care, whether it's the results ofdrug company tests that failed or all the data contained in lost andscattered paper medical records, come at a great cost to medicalprogress.
health-science@washpost.com
Longman is the author of 'Best Care Anywhere: Why VA HealthcareIs Better Than Yours.'
