Last Well Person

Last Well Person: How to Stay Well Despite the Health-Care System

NORTIN M. HADLER
Copyright Date: 2004
Pages: 328
https://www.jstor.org/stable/j.ctt81bhx
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  • Book Info
    Last Well Person
    Book Description:

    Hadler systematically builds the case that many medical interventions are hazardous to our health. Especially insidious is the misuse of longevity statistics in turning the difficulties experienced through a natural course of life, such as aging and osteoporosis, into illnesses. He argues that unfounded assertions and flagrant marketing have led to the medicalization of everyday life and he offers practical solutions on such topics as aging, obesity, adult onset diabetes, and back problems. In The Last Well Person Hadler addresses the tough questions about our health care, cutting through the medical white noise.

    eISBN: 978-0-7735-7225-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-2)
  4. Prologue
    (pp. 3-8)

    If you want to be well and feel well, I have written this book for you. Some of you think you are well, but occasionally you succumb to nagging doubts. Even those of you who are convinced you are well must continually withstand badgering assaults from a variety of health promoters. Some of you are overcoming encounters with illness; others are trying to put such episodes into perspective. If you really feel you are well, however, it’s due to your inherent sense of invincibility. You counter any moments of uncertainty about your wellness with the firm inner conviction “I’m all...

  5. PART ONE: THE METHUSELAH COMPLEX
    • [PART ONE: Introduction]
      (pp. 9-16)

      Daily we hear of the greying of America. We are offered the image of the “baby boom” generation going on forever, making impossible demands on successive generations to provide pensions, health care, and community. Forever? Fear not. The death rate is one per person. The only uncertainties in that regard are when, how it will happen, and what the journey was like.

      More and more of us are living longer than did our parents. Clearly, the likelihood that we will enjoy life as an octogenarian increased over the course of the twentieth century. Far less clear is whether the prospect...

    • 1 Interventional Cardiology and Kindred Delusions
      (pp. 17-34)

      Terms such as myocardial infarction or heart attack, stroke or cerebral vascular accident, and atherosclerosis or hardening of the arteries are darlings of the lay medical press. Pharmaceutical and hospital marketing budgets conspire to hang coronary artery disease like a curse, an imprecation, over North America. Pills, diets, and all manner of regimens are purveyed to ensure that blood continues to flow through the coronary arteries to keep the heart attack at bay. Failing all else, there’s a technological solution — modern cardiovascular surgery and interventional cardiology. The practitioners of these crafts are heroes who apply bypass grafts, angioplasties, and...

    • 2 Fats, Fads, and Fate
      (pp. 35-64)

      There is no question that “cholesterol” is a “risk factor” and that the “statin” family of drugs can lower cholesterol. There is no question that lowering cholesterol in patients who have already suffered a heart attack, or myocardial infarction, will result in a small though measurable decrease in their likelihood of suffering another one, and a smaller, barely measurable increase in their survival rate. However, there are serious questions whether statin treatment affords any meaningful advantage to people who have not had a heart attack. Can we recruit science to answer those questions or even assuage the doubt?

      In one...

    • 3 You and Your Colon
      (pp. 65-76)

      About 1 per cent of the North American population dies each year — approximately 3 million people. The proximate cause of death for 1 million is designated as cardiovascular disease, and another 0.6 million die from cancer, or malignant neoplasms — new growths capable of invading and destroying other tissues. The great majority of cancer deaths occur well after the age of sixty-five.

      Of the 600,000 cancer deaths, a quarter stem from lung cancer. About 10 per cent are from cancer that started in the colon or rectum and spread, or metastasized. Colorectal cancer is followed closely in incidence by...

    • 4 Breast Cancer and How the Women’s Movement Got It Wrong
      (pp. 77-91)

      Heuristics is the branch of logic that offers the option of doing the best you can when faced with uncertainty. Medical heuristics drives all the “rules of thumb,” “common practice,” and “best we can offer, given the lack of evidence” statements that abound in the clinic, at the bedside, and in the lay press. It is more a reflection of preconceived notions than of refutationist science. The twentieth-century saga of breast cancer is an object lesson in medical heuristics. A compelling outcry has driven an impressive response that outpaces the evidence of benefit and, to a considerable extent, has left...

    • 5 Prostate Envy
      (pp. 92-100)

      The prostate is a walnut-sized gland that wraps itself around the male urethra as the urethra travels from the bladder towards the base of the penis. It is arguably more important for its role in disease than its function in health. After mid-life the normal prostate may grow in a disorganized fashion, so that the gland is filled with lumps, or nodules. The lumps that are benign, however, are exceedingly difficult to distinguish by palpation, or touch, from surrounding malignant changes. The time-honoured tradition of the “digital rectal exam” — to palpate the prostate for cancer — turns out to...

  6. PART TWO: WORRIED SICK
    • [PART TWO: Introduction]
      (pp. 101-106)

      The Last Well Person is the one who is able to confront clinical science without being medicalized and to harness it for personal benefit. I have written this book to prepare the reader for this task.

      Part One lays out the clinical science that is relevant to our mortality. That exercise forced us to shed a number of presuppositions, particularly the idea that mortality is an abstraction, a formless beast we can bring to heel by the determined application of the latest and most convincing insights. Our forefathers were frequently seduced by the pronouncements of the sages, particularly the religious...

    • 6 Musculoskeletal Predicaments
      (pp. 107-127)

      Regional musculoskeletal disorders are symptoms that afflict working-age people who are otherwise well, who have no complicating major neurological deficits, and who have suffered no violent or even specific cause. A region of their musculoskeletal system hurts, particularly when that part is used. Most episodes of backache, neck pain, knee pain, shoulder pain, and the like are regional musculoskeletal disorders — and they are common. They rank second as the reason anyone seeks primary medical care, and first as the reason workers suffer long-term disability. They are theraison d’êtrefor entire professions such as the chiropractic, osteopathy, and manual...

    • 7 Medicalization of the “Worried Well”
      (pp. 128-145)

      Someday I hope to hear that a Westerner stood before a Western physician and said, “Doc, I feel awful. Could it be in my mind?” And that the physician replied, “I hope so. That’s a lot better than leukemia, or renal failure, or lupus, or the like.”

      For most Westerners, especially for most North Americans, such repartee is anathema. It is tantamount to an admission of whining or feigning or just being “crazy.” A recent study from Edinburgh confirms that most Westerners are offended by suggestions that their symptoms are in their mind. New patients attending a general neurology outpatient...

    • 8 Turning Aging into a Disease
      (pp. 146-165)

      Is greying a disease? I am not being facetious. Greying is a consequence of biological senescence, of growing old. The follicles that turn skin cells into hair have lost the capacity to introduce pigment. The loss of this biological function results in an obvious biological consequence. Is this consequence pathologic? If so, greying is a disease. If the consequence is not pathologic, greying is “normal.”

      Is greying an illness? For some, grey hair is a symptom, a biological event that is cause for concern and discomfit. For these people, greying is an illness, often an illness for which recourse is...

    • 9 Health Hazards in the Hateful Job
      (pp. 166-176)

      Some of the hazards to our well-being lurk in the course of living. They are aspects of our interactive worlds, our ecosystems, that can perturb our biology and control our fate. Two have emerged that are particularly powerful and that threaten our longevity far more than such recognized causes as hypertension, obesity, or adult onset diabetes. Both of these life-course hazards relate to impediments to the pursuit of gainful employment.

      A lifetime tottering on the edge of poverty is a lifetime likely to be mean, often discouraging, sometimes desperate — and also short. What is it about a compromised socioeconomic...

    • 10 Why Are Alternative and Complementary Therapies Thriving?
      (pp. 177-200)

      Alternative therapies are a controversial topic, one that challenges the objectivity of all health-care professionals. I shall use them as an opportunity to revisit the themes of this book from a different slant. To begin, I’ll be open about my own prejudices.

      I am convinced that complementary and alternative therapies thrive best whenever my guild, which requires an MD for admission, is behaving in an unconscionable manner.

      I can countenance no treatment modality or treatment act that has an unfavourable benefit/risk ratio, regardless of the purveyor.

      I am willing to share the cost for someone to query whether the benefit/risk...

  7. Epilogue: A Ripe Old Age
    (pp. 201-206)

    The overarching theme ofThe Last Well Personis authority — the authority of medicine. This authority is not the same as that of your physician. Rather, the authority of which I speak belongs to the institution of medicine, the organizational structure to which your physician must conform. To paraphrase Robespierre, institutions are born to die; it is the people who are born to live. The twentieth century has witnessed the birth of two institutions of medicine: the first elevated medicine to be the arbiter of normalcy; the second superimposed the trappings of enterprise and created the “health-care delivery system.”...

  8. Annotated Readings
    (pp. 207-262)

    Karl Popper described truth as tentative at best, the hypothesis yet to be disproved. See hisConjectures and Refutations (2000), first published in 1963. David Miller,Popper Selections(1985), introduces Popper’s social philosophy as well as his philosophy of science. The biography by Malachi Hacohen,Karl Popper: The Formative Years(2000), is also engaging and informative.

    Popper’s refutationist treatment of truth was as discomforting as it was revolutionary. Is there no way to generate more certainty? Epistemology since Hume has sought reasonable compromises that might offer some hope of a valid approximate. Inferential reasoning relies on documenting the consistency of...

  9. Bibliography
    (pp. 263-300)
  10. Index
    (pp. 301-314)