Not as easily comprehensible, esp. for the vulnerable in the target audience, as [b:Rethinking Aging: Growing Old and Living Well in an Overtreated Society|12022065|Rethinking Aging Growing Old and Living Well in an Overtreated Society|Nortin M. Hadler|http://d202m5krfqbpi5.cloudfront.net/books/1348290973s/12022065.jpg|16987674]. However, well worth reading. Good science that busts not only alternative treatments such as homeopathy but established procedures such as angioplasty, statins, and even routine mammograms.

I've always been a skeptic, and proud of it, and I know about controlled randomized double-blind trials, placebo effect, and absolute vs. relative percentages. I also have excellent role models - my 71 yo parents are healthier than I am because they're too busy working & playing and loving life to get sick or to complain of normal aches & pains. Neither take any medicines except, rarely, aspirin. So I'm predisposed to agree with Hadler's message, to the point where I didn't read any of the supplementary material.

So, I tried to counter my bias by looking for flaws in his lessons. The main one is that he generally looks at end outcomes. If a treatment or procedure doesn't prolong life itself, he implies he's not interested. But some treatments make the final few years more enjoyable, despite not delaying the inevitable, and he doesn't address them.

One exception is heart surgery. The angioplasty/stent therapy did not save a life; it didn't even spare anyone a heart attack over the next five years."

He also doesn't talk about treatments that are worth getting. What should a doctor do, if not the long list of things s/he shouldn't do, according to Hadler? Treat injuries, of course. And dangerous contagious diseases, I'm sure (as opposed to contagious diseases that will run their courses without interventions).

I figured out, too, that it's ok with Hadler to see a Dr. if you've a complaint that you suspect might be a marker for something that actually can and should be treated. Hadley's big on the illness-disease paradigm. If the illness (say, rheumatism) is, in a particular patient, marking a disease (rheumatic fever), and we have a proven effective treatment for the disease, we can treat the disease.

For example, though, aging is not a disease. There are a lot of illness that are indicative of aging, but to treat them would be to commit what Hadler calls Type II Medical Malpractice - good treatment that should not be performed. Ex: Osteopenia is a social construction, BMD screenings are a waste of resources, and biophosonates are more likely to harm than to help.

Back to the example of my parents. The main predictors of health and longevity are career satisfaction and a comfortable lifestyle (SES). Hadler relates: Two different UPS shipping warehouses. Both with standardized procedures, wages & benefits. One with a despised boss, one with a respected boss. Guess which had lots more worker's compensation claims for back injuries? Were those workers really getting injured more often? No. Were they shamming? No. They unconsciously felt twinges to be debilitating because they hated their job and couldn't cope with the pain on top of that.

Hadler's advice is basically to buck up and cope if you can, and if you need help, don't turn first to pills & potions & procedures. Recognize that your mind is a part of your body, and is powerful enough to affect the well-being of your body, and address your state of mind. Don't let yourself be defined as a patient. Retain your personhood.

Ex: "Fibromyalgia denotes nothing more than persistent widespread pain. However, in the labeling, the patient is forever changed.... In the community, the majority of people with persistent widespread pain improve with time, but those labeled as 'fibromyalgia' seldom do.... the treatment is iatrogenic.'" (Hadler does of course admit that efffective treatments may possibly be developed soon, but this book is 2008, and I, for one, would not take a drug that was developed only five years ago.)

I'll leave you to read the book so you can see the further example of the prostrate. Hint - about what this review has taught you so far, and predict what the author will discuss in "The Prostrates of Seattle vs. the Prostrates of Connecticut."

Bottom line: "If any clinical interaction has been studies and cannot be shown to be meaningfully effective, it is worthless at any cost."

An interesting resource: Memorial Sloan-Kettering Cancer Center's herbs website - http://www.mskcc.org/aboutherbs." ( )

This tome on the over-treated, over diagnosed, over drugged world of America is interesting. The author’s premise is that we are beset with rampant Type II Medical Malpractice – the performance of unnecessary testing, diagnosing, and prescribing. He seems to perceive that we are, as a culture, drug addicts of the first order, responding to the programmed prescription of pharmaceuticals by doctors who mindlessly follow the lead of drug companies and studies financed by the same folks. In the course of this herd-like plunge off the cliff, we are engaged in a huge wealth transfer from all of us to the medical establishment. What is our reward? The lowest life expectancy of any major country!

Of course, this is the issue of the moment for our new President Obama, who seems obsessed with expanding this process.

Whether your concern is cholesterol, blood sugar, blood pressure, breast cancer, prostate cancer, dietary supplements, hormone replacement therapy, osteopenia, backaches, over or under-working, or whatever, Dr. Hadler offers a critical evaluation of the practical realities of studies, most of which are read to mean that current treatments are no better than placebos.

Dr. Hadler’s view seems to be that we all live, on average, to be about 85. By that time, we will all have our fair share of diseases and will die from one or more of them. We will be best advised if we have a trusted physician who will evaluate our maladies, advise of the realities of the treatments, and then let us take a proactive role in our own self-medication. He nowhere exactly says this, but the result seems clear enough.

This is a marvelous book that should be must-reading for anyone who is concerned about any of these things – which is all of us.

For me, Dr. Hadler’s excellent analysis made me revisit my own mother’s breast cancer treatment in the 1950s. I think that she endured a mutilation that was probably needless, did not extend the length of her life, and surely devastated the quality of her life. I hope that you are all spared such a fate. Read about being worried sick! ( )