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Getting What We Deserve

Health and Medical Care in America

Alfred Sommer, M.D., M.H.S. Former Dean, Johns Hopkins Bloomberg School of Public Health

Publication Year: 2009

One of America's leading public health experts finds a host of ills in this country's health care system: • The United States spends nearly twice as much on health care as the rest of the developed world, yet has higher infant mortality rates and shorter longevity than most nations. • We have access to many different drugs that accomplish the same end at varying costs, and nearly all are cheaper abroad. • Our life span had doubled over the past century before we developed effective drugs to treat most diseases or even considered altering the human genome. • The benefits of almost all newly developed treatments are marginal, while their costs are high. In his blunt assessment of the state of public health in America, Alfred Sommer argues that human behavior has a stronger effect on wellness than almost any other factor. Despite exciting advances in genomic research and cutting-edge medicine, Sommer explains, most illness can be avoided or managed with simple, low-tech habits such as proper hand washing, regular exercise, a balanced diet, and not smoking. But, as he also shows, this is easier said than done. Sommer finds that our fascination with medical advances sometimes keeps us from taking responsibility for our individual well-being. Instead of focusing on prevention, we wait for medical science to cure us once we become sick. Humorous, sometimes acerbic, and always well informed, Sommer’s thought-provoking book will change the way you look at health care in America.

Published by: The Johns Hopkins University Press


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pp. vii

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pp. ix

This book presents a personal perspective about things that make a difference in the health of individuals and of populations. After forty years straddling the divide between clinical medicine and public health, I find that information on critical issues can be too...

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1. GENESIS: From Few to Many—in Fits and Starts

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pp. 1-9

Populations grow when the number of children who are born and survive exceeds the number of people who die. For most of human history, life was “nasty, brutish, and short,” and life and death were exquisitely balanced. ...

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pp. 10-25

We’ve come to think of disease as an abnormal condition caused by a single, specific biological agent, such as a microbe or a mutated gene. Many such singular biological agents have been discovered. But health is not merely the absence of disease, nor do the origins of disease lie solely in the biological sphere. ...

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3. GENES: Sometimes “Destiny,” Sometimes Not

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pp. 26-31

So much has been written about the future benefits of the “genetic revolution” that it is left to me to play the Grinch. A little balance and reality testing are in order. ...

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pp. 32-36

Disease and health are the outcome of complex, intersecting influences. Genes might vary the risk of lung cancer among smokers, but if you don’t smoke, it is far less likely that you will get lung cancer. That’s pretty straightforward. ...

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pp. 37-53

Many of our health problems are self-inflicted, things that we can do something about. One of “public health’s” greatest modern triumphs was turning back the epidemic of cardiovascular disease that struck the United States after World War II. ...

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pp. 54-66

To choose healthier behaviors, we need to know what makes and keeps us healthy. Unfortunately, much of what we are told simply isn’t true. Researchers overinterpret their data; medical journals, in a competition to be quoted, overstate the relevance of the results; ...

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7. FROM SCIENCE TO POLICY: The Path Is Anything but Linear

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pp. 67-72

Moving from data to policy (and practice) is a lot more complex and idiosyncratic than an outsider might suspect. I’ve outlined, in brief, the major steps (Figure 19). The process begins with scientific evidence. Sometimes, as is commonly the case for new drugs, the initial evidence is entirely unexpected. ...

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pp. 73-108

The U.S. health care system is the subject of multivolume tomes. It is too complex and has too many moving parts for it to be described in any detail in a single chapter, much less to provide a prescription for its salvation. ...

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pp. 109-114

“Health disparities” is the new rallying cry among those concerned about social equality. I’m not talking about the great divide between people living in wealthy, stable nations and those living in countries that are poor and politically turbulent. ...


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pp. 115-121

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Further Reading, Films, and Websites of Interest

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pp. 123-125

The number of books, journal articles, movies, and Websites relevant to the subjects I’ve discussed is virtually limitless. For those with the time and interest, I list here a few of my favorites. They add considerable depth and color to this book’s summary of core principles. ...

Index [Includes About the Author]

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pp. 127-133

E-ISBN-13: 9780801898600
E-ISBN-10: 0801898609
Print-ISBN-13: 9780801893872
Print-ISBN-10: 0801893879

Page Count: 152
Illustrations: 2 halftones, 31 line drawings
Publication Year: 2009