Worried Sick: A Prescription for Health in an Overtreated America Book

Nortin Hadler is a rheumatologist with a mission. That mission is to overhaul the US healthcare system to eliminate "Type II Medical Malpractice." If Type I Medical Malpractice is doctors doing their job poorly, Type II is doctors doing their job unnecessarily. According to Hadler, unnecessary medical procedures are at the root of many of our health care woes.

His stated goal in writing this book is to educate patients about what science really says regarding the effectiveness of many common procedures so that they can make truly informed decisions. Towards this goal, he outlines a number of concepts that are important for anyone with medical problems to understand. One of these is the distinction between relative and absolute risk. If a procedure is said to reduce the chance of developing a certain problem by 50%, that may sound impressive until it's revealed that the absolute risk drops from 1% to .5%. Hadler stresses that understanding the reduction in absolute risk is crucial to knowing whether the costs and potential side effects of a procedure are really worth it.

Hadler proposes that any medical treatment that requires intervention on 20 or more patients before one of them experiences benefit is simply too inefficient, costly and risky to be subsidized by our insurance system. The book contains detailed individual chapters that address how he uses this criteria to reject many common treatments including coronary artery bypass grafts, angioplasties, and stents, surgery for backache, statin therapy to reduce cholesterol, PSA screenings and radical prostatectomy, drugs for decreased bone density, and screening mammography. Supplementary readings in the back of the book address his rational for rejecting these treatments in more depth.

Having recently turned 40 and dutifully received my first "baseline mammogram" along with strict instructions to return every year from now until eternity despite my lack of overall breast cancer risk, I found a great deal of Hadler's information extremely valuable. Though I disagreed with him on some points, he makes a compelling case that the pushing of many of these procedures by those who stand to profit from them is done at the expense, rather than the benefit, of most patients.

As fascinating as I found many of his arguments, however, I did not particularly enjoy reading this book. Though ostensibly written for patients, it was a step above what I could easily understand and certain things were not explained as clearly as I would have liked. In addition, Hadler's tone comes across at times as grumpy and arrogant, so while he has a lot of interesting things to say, he's not very much fun to be around.

In addition, I find it hard to be optimistic about Hadler's chances of reforming our current health care system (which he has already been trying to do for years.) Though his ideas may be grounded in scientific rationality, people diagnosed with a scary illness are rarely functioning from a rational place. I think it would take a radical shift in American consciousness before people could accept the fact that treating certain diseases, particularly later in life, just doesn't make sense. Humans are just too prone to thinking that we will be the exception who would really benefit from the expensive options our vested medical profession is all too happy to offer us.