More Harm Than Good

C O N T E N T S

F O R E W O R D i x

I N T R O D U C T I O N

1 The Medical Prognosis—Why More Is Not Necessarily

Better 1

Taking the Data to Heart 2

The Modern Doctor’s Dilemma 5

A Deadly Intersection:: Soft Medicine and Hard

Technology 6

Understanding the Odds Can Even Them 7

The Evolution of Medical Knowledge 8

The Difference Between Trends and Individuals 10

2 Dissecting the Practice of Medicine 13

The No-Sum Game 16

The Value You’re Getting 25

Painting by Numbers 29

Flipping a Coin on a Heart Attack 30

A Stroke in the Eye 32

Under Pressure 34

Beyond Medicare 35

Is It as Bad Among Younger Populations? 36

3 Nothing Exceeds Like Excess 41

More Room at the Inn Means More Treatment 47

The Dollar Cost of Variability in the Latter Years of Life 51

Many Captains, One Ship 51

Following the Money 53

What Is to Be Done? 55

. . . And the Patient’s Preferences 58

. . . And the Doctor’s Preferences 59

4 Are You Past Your Expiration Date? 63

The Price of Living Past Your Expiration Date 64

The Body’s Expiration Date 65

Deadly Turnover 70

5 Screening Out Common Sense 75

How Doctors Make Decisions During Checkups 76

What ‘‘Sensitive’’ and ‘‘Specific’’ Mean 79

The Gold Standard in Strep 80

Good Test, Bad Test:: Same Test 82

The Popularity of Screening—Uncle Ivan and the CT

Scan 83

Terrorized by Technology 86

Screening Gone Awry 88

Pitfalls and Promises in Cancer Screening Tests 91

Length- and Lead-Time Bias 91

Testing For Prostate Cancer 96

What Makes Sense? 104

6 News from the Front:: The War on Prostate and Other

Cancers 109

How Cancers Cause Problems 112

A Closer Look at Cancer:: Incidence and Impact 113

The Rise in the Rates of Prostate Cancer 115

What About Other Cancer’s Incidence Rates and

Prognoses? 119

Some Hopeful News from the Front on the War on Cancer::

What Might Be Around the Corner 121

7 Diabetes:: Things You May Not Know 125

What Is Diabetes? 126

The Use and Abuse of Glucose 127

Two Types of Diabetes 129

Glucose:: The Small Molecule That’s a Big Deal 132

Should High Glucose Levels Be Fixed? 134

So What Makes Sense for Patients with Type II

Diabetes? 138

8 Why Some Think Threading the Artery Is Easier Than

Threading the Needle in Cardiovascular Disease 143

Putting a Price on Quality of Life 144

What Interventions Are Available to Prevent CVD? 147

9 Degenerative, Infectious, and Autoimmune Diseases 155

The First Line of Defense 157

Recent Breakthroughs in Understanding the Immune

System 158

The Autoimmune Diseases 161

Do We Really Knee-d This? 165

Making a Pain in the Neck Even Worse 169

Infection

More on Degenerative Diseases 175

10 Making the Best Medical Decisions for You 179

The ‘‘All You Should Eat’’ Special 180

Oils from the Sea and the Tree 181

All That Is Sweet Isn’t Good 184

A Hard Look at Supplements 186

An Aspirin a Day . . . 187

The Wages of Sweat 188

Additional Benefits of Exercise 191

But Doctor, Why Is My Attempt at Weight Loss Taking So

Long? 192

Watch Your Mouth, Young Man (and Woman) 193

Examining the Physical Exam 196

A Pocket Summary 198

11 How to Do More Good than Harm 203

Turning Things Around:: The Payers and Players 000

Revamping Medical Education:: Undergraduate and Post-

Graduate Studies 216

Providing Medical Care Based on Scientific Evidence 219

The Need for Universal Coverage 222

Electronic Medical Records and the Internet 224

Bringing It All Together:: A Comprehensive Unified System

of Payment (‘‘CUSP’’) 225

I N D E X