September 2005

 

The Last Well Person: How to Stay Well Despite the Health-Care System, Nortin M. Hadler, M.D., McGill-Queen’s University Press (2004).

 

Have you ever wondered why our health care system is the most expensive in the world, yet Americans live no longer and appear no healthier than people in other developed countries?  The answer, per Dr. Hadler’s book, is that many sophisticated and expensive medical procedures provide marginal benefits at best for the patients on which they are used.

 

Take the use of “statin” drugs (“Lipitor” et al.) to lower cholesterol levels, a regimen relentlessly touted by “talk to your doctor” ads on television.  Millions of Americans seem to be listening, given the sale of these drugs, but Hadler is skeptical..  Lowering cholesterol with drugs makes sense for patients who have already suffered a heart attack, he says, but clinical studies don’t demonstrate a statistically significant benefit for people who have not.

 

 Also, statins can cause a severe destruction of muscles.  One of these drugs (Baycol) was pulled from the market after fifty or more fatalities, Hadler points out, and long-term experience with statins is limited.  “For all I know,” he continues, “insidiously progressive muscle disease, liver disease, or cognititve impairment lurks in the distant future of some of the men who[are taking them].”

 

Hadler also questions the widespread acceptance of many other medical procedures, including heart bypass surgery (no discernible survival advantage for 97% of patients with angina), PSA screening for prostate cancer (“there’s only one problem: it doesn’t work”), and the use of Celebrex and Vioxx in lieu of older analgesics (written before accumulating evidence of a linkage between Vioxx and heart attacks caused Merck to pulled their drug from the market).

 

There’s lots of medical terminology in “The Last Well Person,” and many people won’t want to read it from cover to cover.  However, readers can readily scan the table of contents and pick the chapters of greatest interest to themselves.