Getting What We Deserve

Contents

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pp. vii-

Preface

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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...

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. ...

2. DISEASE IS THE SUM OF ALL EVILS

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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. ...

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. ...

4. THE COMPLEX NATURE OF CAUSALITY

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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. ...

5. THE CONSEQUENCES OF OUR OWN BEHAVIOR

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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. ...

6. CHOOSING THE HEALTHIER LIFESTYLE

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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; ...

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. ...

8. THE U.S. HEALTH CARE SYSTEM

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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. ...

9. WHO’S HEALTHY? WHO’S NOT? WHY?

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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. ...

Notes

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pp. 115-121

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