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New book by UNC physician criticizes ‘medicalization’ of everyday life
CHAPEL HILL -- A new book by a University of North Carolina at Chapel Hill School of Medicine faculty member offers provocative observations on the health-care system, including his assertion that everyday life is becoming “medicalized.”
Sept. 23, 2004
New book by UNC physician criticizes ‘medicalization’ of everyday life
By TOM HUGHES
UNC School of Medicine
CHAPEL HILL -- A new book by a University of North Carolina at Chapel Hill School of Medicine faculty member offers provocative observations on the health-care system, including his assertion that everyday life is becoming “medicalized.”
“The Last Well Person: How to Stay Well Despite the Health-Care System,” recently published by Montreal-based McGill-Queen’s University Press, also is featured in an article in this week’s (Sept. 20) issue of American Medical News (amednews.com), published by the American Medical Association.
The book’s author is Dr. Nortin M. Hadler, a professor of medicine and microbiology-immunology in the School of Medicine and an attending rheumatologist at UNC Hospitals.
Among Hadler’s observations are that: heart bypass surgery is usually a waste of money, time and energy and, like screening for prostate cancer, does more harm than good; testing for breast cancer is not always useful or effective; and nothing of substance is accomplished by treating the cholesterol or bone density of well people.
His book looks at the wealth of epidemiological data to tease out factors that influence the “when” rather than the current emphasis on “what” causes death. The book examines the literature of social epidemiology to discern factors that might assist individuals in coping with life’s unavoidable challenges rather than assume that all life’s unavoidable challenges are diseases to be treated.
“The book is not a compendium of answers, or even questions,” said Hadler. “It is a series of object lessons designed to teach the well reader how to make informed decisions about their own health care.”
Hadler makes his case against heart bypass surgery in a chapter titled “Interventional Cardiology and Kindred Delusions.” There he writes that three clinical trials have shown 97 percent of patients who undergo the surgery receive no survival benefit as a result. Yet about 500,000 heart bypass surgeries are performed nationwide each year, incurring untoward outcomes that overwhelm any potential benefit, Hadler said.
Similarly, in a chapter titled “Prostate Envy,” Hadler cites studies concluding that surgery for prostate cancer does not prolong the life of men who have it; the surgery simply reduces the likelihood that prostate cancer will be the direct cause of death. In a separate chapter on breast cancer, Hadler writes that early detection only benefits women whose breast cancer is a threat to their longevity. Early detection provides far less benefit as a woman gets older, he writes.
“If you are approaching old age, or you are young but already burdened with diseases actively assaulting your longevity, breast cancer is less a malignant specter and, in all probability, the least of your problems,” Hadler writes in the chapter on breast cancer.
The book’s title borrows from a fictional case study by Dr. Clifton Meador, “The Last Well Person,” which was published in the New England Journal of Medicine in 1994. Meador, executive director of the Meharry-Vanderbilt Alliance in Nashville, Tenn., called Hadler’s book a “basic primer for those who want to live happy lives free of the current excesses of health care.”
Photo note: A photo of Hadler is available at http://www.unc.edu/news/pics/faculty/hadler_nortin.jpg
Note: Contact Hadler at (919) 966-4191 or nmh@med.unc.edu. The American Medical News article that mentions his book is at http://www.ama-assn.org/amednews/2004/09/20/hlsa0920.htm
School of Medicine contact: Stephanie Crayton, (919) 966-2860 or scrayton@unch.unc.edu