Bad medicine and what can be done about it

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BOOK REVIEW

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Bad medicine and what can be done about it

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By Rich Barlow, Globe Correspondent  |  March 20, 2005

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At 22, Jennifer Rufer yearned for a big family.

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Then blood tests indicated the Seattle woman had uterine cancer.

Chemotherapy failed to stem the disease, so she had a hysterectomy. Part

of her lung was removed out of concern that the cancer had spread.

Still, the tests -- 44 in all -- were bad. Shrinking from weight loss,

she posed with her husband at Christmas for what both assumed would be

their last holiday photo.

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But a new test showed in 2001 that the earlier results had been false

positives. Rufer never had cancer. A lawsuit made her a millionaire.

Nothing, unfortunately, could ever make her what she longed to be, a

birth mother.

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This was an extreme example of an all too common problem, Richard Deyo

and Donald Patrick write in ''Hope or Hype, " a relentless indictment of

the business of American medicine. At best, they contend, too much

healthcare is ineffective, squandering precious dollars. At worst, as in

Rufer's case, the care can be downright hazardous.

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Business is partly to blame, according to the authors, a doctor and

health services professor, respectively, at the University of

Washington. Too often, physicians and the makers of drugs and medical

devices cut sweetheart deals in which the manufacturers ply doctors with

gifts or ''consulting " fees in exchange for using their products,

regardless of their superiority.

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But the rest of us are on the hook: patients, for simultaneously

demanding inexpensive care and the latest, priciest treatments, even if

they're unproved; insurance companies, which aren't rigorous enough in

insisting that coverage go for documented effective treatments; and the

government, which permits all this.

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The growth of modestly effective but costly treatments ''is the main

reason why health insurance costs are rising so fast, with so little to

show for it in terms of longevity or other public health statistics " in

which other industrialized nations outdo us, according to the authors.

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Written in plain if often unexciting English, ''Hope or Hype " doubtless

is too wonkish for some readers. But those for whom talk of HMOs and

PPOs is like a heavenly chorus will find much to ponder in this

encyclopedic dissection of an undeniably life-or-death topic. And

personal stories like Rufer's animate the chin-scratching analysis with

real people.

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The authors suggest an array of fixes, starting with evidence-based

medicine, by which they mean treatments, drugs, and devices that have

been run through the scientific colander of randomized trials. Readers

who assume medicine is already based on evidence will be stunned to

learn the flimsy science undergirding those alleged miracle drugs

advertised on TV or even some treatments prescribed in good faith by

their family physician.

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'' 'Science' has often meant inferences drawn from what we know of human

physiology and disease behavior, information from studies of animals, or

expert opinions, " the authors write.

Or, as the doctor says to his patient in one of the many amusing

cartoons reproduced in the book, ''Take these pills three times a day,

unless you read in the paper that they've been proven ineffective. "  

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© Copyright 2005 The New York Times Company