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Worried Sick (New Edition)

Paperback Edition — A Prescription for Health in an Overtreated America

Nortin M. Hadler M.D.

Publication Year: 2012

Nortin Hadler's clearly reasoned argument surmounts the cacophony of the health care debate. Hadler urges everyone to ask health care providers how likely it is that proposed treatments will afford meaningful benefits and he teaches how to actively listen to the answer. Each chapter of ###Worried Sick# is an object lesson on the uses and abuses of common offerings, from screening tests to medical and surgical interventions. By learning to distinguish good medical advice from persuasive medical marketing, consumers can make better decisions about their personal health care and use that wisdom to inform their perspectives on health-policy issues.

Published by: The University of North Carolina Press

Quotes, Title Page, Further Reading, Copyright, Dedication

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pp. i-vi

Contents

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pp. vii-ix

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Foreword

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pp. xi-xiv

Anyone who has gone up against a powerful establishment knows that assuming the role of a dissident can be a lonely place, and there are few enterprises more powerful, both economically and culturally, than American medicine. In Worried Sick, Dr. Nortin Hadler bravely takes on both his own...

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Preface to the Paperback Edition

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pp. xv-xviii

In the fall of 1964 the first-year class assembled in a large amphitheater in one of the neo-classic marble buildings that defined a quadrangle as awe inspiring as any in the Roman Empire. The purpose of the assembly was to hear an address that welcomed them to Harvard Medical School and to medicine. The...

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Acknowledgment

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pp. xix-

Publishing books has been a major part of my career, books written for physicians and scholars who share my research interests. Publishing books for a general audience is an...

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Introduction

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pp. 1-8

The social construction of health in the United States, and to a lesser degree elsewhere, has features that are counterproductive. We are becoming increasingly medicalized, made to think that all life’s challenges demand clinical intervention, when the science dictates otherwise. We are at grave risk of what...

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One: The Methuselah Complex

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pp. 9-14

Do you know when you want to die? If you could, would you choose the date? “Never” is not an option; the death rate is one per person. “When?” is the profound and bedeviling enigma. Ending one’s own life raises great issues in moral relativism, as great as does ending the life of another. Prolonging life also...

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Two: The Heart of the Matter

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pp. 15-32

Interventional cardiology and cardiovascular surgery are the cash cows of, if not the engines driving, all that is indefensible about the American health-care delivery system. I’m not accusing interventional cardiologists and cardiovascular surgeons of malfeasance. Some may be deserving of such condemnation...

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Three: Risky Business: Cholesterol, Blood Sugar, and Blood Pressure

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pp. 33-56

Cognitive dissonance is the confusion we experience when we attempt to meld two contradictory ideas. Americans who are concerned with their health are reeling from cognitive dissonance: obesity, high blood pressure, diabetes, and high blood cholesterol are epidemic threats to our lives, yet America is graying...

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Four: You Are Not What You Eat

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pp. 57-64

In 2005 it was considered reprehensible to feed your child butter; today, it’s reprehensible to feed your child margarine. You must be thin, but not too thin. Bran is fast fading as a salutary “must” that lowers your cholesterol and burnishes your colon. Now eating some fish will save your life thanks to omega-3...

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Five: Gut Check

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pp. 65-76

About 1 percent of the U.S. population dies each year; let’s say that’s 3 million people. The proximate cause of death for 1 million is designated as cardiovascular disease. The proximate cause of death for another 0.6 million is malignant neoplasms (i.e., cancer). The great majority of cancer deaths occur after age...

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Six: Breast Cancer Prevention: Screening the Evidence

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pp. 77-94

This chapter is particularly challenging to write. Breast cancer is a topic that seldom countenances dispassionate, let alone objective, treatment. There is good reason for that. The topic roils with gender issues and object lessons in medical heuristics. Even today, when they are widely recognized, the existence of..

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Seven: The Beleaguered Prostate

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pp. 95-104

Interspersed between all the direct-to-consumer drug advertisements, the hawking of the latest procedures and gimmicks by providers, and the boasting of the prowess of the local or not-so-local hospital are the announcements of health-promotion, disease-prevention, public-service programs. Your friendly...

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Eight: Disease Mongering

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pp. 105-110

We are a country of obese, hypercholesterolemic, hypertensive, diabetic, osteopenic, depressed, pitiful creatures perched on the edge of a cliff staring at condors: cancer, heart attacks, strokes, dementia, fractures, and worse. We fear for our future. We teach our children that they, too, must live in fear for their...

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Nine: Creakiness

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pp. 111-134

We live in a time when science seems to be bursting with promise. Details of the very latest in diagnosis and treatment find their way into the headlines of print media and the feature stories of broadcast media. We are told to expect cures. All of us respond with great anticipation, some with speculative...

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Ten: It’s in Your Mind

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pp. 135-152

In chapter 8, I reviewed the literature that supports my argument that to be well is not to be spared symptoms (morbidity) but to have the wherewithal to cope with intermittent and remittent morbid predicaments such as creakiness, heartache, heartburn, and much more. In this chapter I want to explore the...

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Eleven: Aging Is Not a Disease

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pp. 153-170

We will all die. Dying is not a disease; it is as much a fact of life as being born. The process of dying can be a disease, and too often in the United States it is an iatrogenic disease. But die we must. Very, very few of us will get to die as nonagenarians, though many will come close (see chapter 1). The biological...

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Twelve: Working to Death

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pp. 171-190

Chapter 1 introduced the notion that longevity in a resource-advantaged country is largely predicated on socioeconomic status and employment. The most powerful life-course hazards relate to impediments to the pursuit of nurturing, gainful employment. That such is true for any...

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Thirteen: “Alternative” Therapies Are Not “Complementary”

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pp. 191-212

As you no doubt understand by now, to be well is not the same as to feel well. To be well requires some sense of invincibility. No one is spared symptoms for long. It’s abnormal to go one year without upper respiratory symptoms or pain, notably backache. Lurking in our future are heartache and heartburn...

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Fourteen: Assuring Health, Insuring Disease

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pp. 213-228

Teaching medicine at the bedside is my calling. As I said in the introduction, I know no higher calling. About a decade ago, when my skills as a bedside teacher were finely honed, I found myself faced with one of Robert Frost’s forks in the road. I was invited to round as visiting professor around the world, and I...

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Supplementary Readings

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pp. 229-310

There are three concepts put forth in the introduction that are crucial to understanding the basis of Worried Sick. One relates to the philosophy of science, one to the social components of morbidity, and one to medicalization. It is easy to paraphrase the central point of Karl Popper’s philosophy of science. He described truth as tentative at best. Truth is the hypothesis yet to be...

Bibliography

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pp. 311-354

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About the Author

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pp. 355-356

Nortin M. Hadler, M.D., M.A.C.P., M.A.C.R., F.A.C.O.E.M. (A.B. Yale University, M.D. Harvard Medical School) trained at the Massachusetts General Hospital, the National Institutes of Health in Bethesda, Maryland, and the Clinical Research Centre in London. He joined...

Index

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pp. 357-376

Further Reading

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pp. 377-


E-ISBN-13: 9781469602233
E-ISBN-10: 1469602237
Print-ISBN-13: 9780807872338
Print-ISBN-10: 0807872334

Page Count: 392
Illustrations: 2 line drawings, 1 map
Publication Year: 2012

Edition: Paperback Edition
Series Title: H. Eugene and Lillian Youngs Lehman Series