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Worried Sick

Worried Sick: A Prescription for Health in an Overtreated America

Nortin M. Hadler
Shannon Brownlee
Jeanne Lenzer
Copyright Date: 2012
Pages: 392
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  • Book Info
    Worried Sick
    Book Description:

    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 ofWorried Sickis 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.

    eISBN: 978-1-4696-0223-3
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. foreword
    (pp. xi-xiv)
    Shannon Brownlee and Jeanne Lenzer

    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. InWorried Sick, Dr. Nortin Hadler bravely takes on both his own profession and the industry it serves, along with the culture of medicalization that has grown in parallel with the expansion of health care as the dominant sector of the nation’s economy. There are two central and vital messages in this book. First, Hadler clearly believes that many of the medical services — the...

  4. preface to the paperback edition
    (pp. xv-xviii)
  5. acknowledgment
    (pp. xix-xx)
  6. Introduction
    (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 I call “Type II Medical Malpractice” — doctors doing the unnecessary, albeit very well (as opposed to Type I Medical Malpractice, which is doctors doing the necessary unacceptably poorly). Until the public at large comes to recognize the dangers of medicalization and Type II Medical Malpractice and decries both, there will be no pressure...

  7. chapter one The Methuselah Complex
    (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 raises issues in moral relativism. Should we go to lengths to prolong all life, or just life we deem sufficiently high in quality? Hence, “When?” is pregnant with, “How goes the journey?”

    These are questions for the ages. The authors of the Old...

  8. chapter two The Heart of the Matter
    (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, but I assume that most are caught up in the folly of peer review. They are so convinced that what they do advantages patients, they are hell-bent to do it better. Furthermore, they are so handsomely rewarded, in acclaim if not monetarily, that it would seem counterintuitive if not absurd to question what they do. Not only would...

  9. chapter three Risky Business: Cholesterol, Blood Sugar, and Blood Pressure
    (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 so rapidly that nothing can save the Social Security and Medicare funds from collapse.

    This chapter and many that follow will teach you how to filter the pronouncements of authorities that relate to your health. With a few skills and rules, the exercise is far less tenuous than that which we undertake every day...

  10. chapter four You Are Not What You Eat
    (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 content, unless the mercury content does you in first. A diet low in carbohydrate is good for you, or not. A diet low in fat is good for you, or not. Red meats are bad, except maybe a little is okay; white meats are good unless...

  11. chapter five Gut Check
    (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 sixty-five, well after age sixty-five.

    One-quarter of the 600,000 cancer deaths are from lung cancer. About 10 percent are from colorectal cancer, followed closely by death from prostate and breast cancer. This chapter considers whether a well person is well advised to go to lengths to be spared...

  12. chapter six Breast Cancer Prevention: Screening the Evidence
    (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 gender biases cannot be overemphasized. No one should be deprived of care of the highest quality for any reason, including gender, ethnicity, and ancestral continent of origin. However, the outcry to redress the gender issues by providing empathic and effective remedies carries an inherent hazard. We need to address past wrongs, but...

  13. chapter seven The Beleaguered Prostate
    (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 health insurer is inducing you to check your cholesterol and blood sugar so that you can be treated early. Someone is urging colonoscopy, others newfangled mammography or total body CT scans, or the like. Blood-pressure cuffs dot the landscape. Health fairs abound. After reading the prior chapters, you will appreciate how much this activity serves purveyors far more effectively than the...

  14. chapter eight Disease Mongering
    (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 futures.

    We mobilize all of our courage when faced with creakiness, achiness, heartburn and heartache, headache and bellyache, constipation or diarrhea, impotence, sleeplessness, and even restless legs. No infant can simply be fussy, and no child can simply be fidgety, obstreperous, or below average in performance. We are told that all...

  15. chapter nine Creakiness
    (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 investing. Hidden in the bluster is another realm of advancement where contemporary science offers more than promise. We are witness to a revolution in our understanding of the aspects of life in “advanced” societies that foster or compromise our sense of well-being and thereby our sense...

  16. chapter ten It’s in Your Mind
    (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 process and consequences of having a “bad day,” a day when we’re indisposed. The reader is advantaged by the fact that I have been musing about this for decades, and my conceptualization has matured, if not ripened. In a monograph published fifteen years ago (Occupational Musculoskeletal Disorders, 1993), I...

  17. chapter eleven Aging Is Not a Disease
    (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 odyssey from birth to death is one of subtle incremental changes, punctuated with occasional drama: puberty, pregnancy, female menopause. Most of the changes we take in stride, even a proud strut. Some changes, like the...

  18. chapter twelve Working to Death
    (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 who have no gainful employment is obvious. A lifetime of poverty, even tottering on the edge of poverty, is a lifetime likely to be base, mean, often discouraging, sometimes desperate — and short. Poverty is defined as a disposable income less than three times what is necessary for subsistence in your community. Some living in poverty are so desperately poor that...

  19. chapter thirteen “Alternative” Therapies Are Not “Complementary”
    (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, shoulder and knee pain, headache, rashes, and skipped heartbeats, not to mention bothersome fatigue, sore muscles, bowel irregularity, insomnia, and so much else to challenge our sense of well-being repeatedly. To be well requires the wherewithal to cope with these predicaments of life until they...

  20. chapter fourteen Assuring Health, Insuring Disease
    (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 did so with pleasure. But whenever I returned to American hospitals, including my own, pleasure in rounding was increasingly contrived. My beliefs as to the reason medicine existed and the directions American institutions of medicine were taking had diverged to such...

  21. Supplementary Readings
    (pp. 229-310)
  22. bibliography
    (pp. 311-354)
  23. about the author
    (pp. 355-356)
  24. index
    (pp. 357-376)
  25. Back Matter
    (pp. 377-377)