The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You can Do to Prevent It

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More About This Book

Overview

With health reform enacted by the Congress and signed by the President, the subject matter of The Treatment Trap is a compelling component in the national debate. Taking advantage of Rosemary Gibson's knowledge gleaned from extended experience in the field of medical care and Janardan Singh's similar knowledge but from a financial perspective, the authors explore the most neglected issue in American medicine today: the overuse of medical care, including needless surgery and other invasive procedures, out-of-control x-ray imaging, profligate testing, and other wasteful practices that have become routine among too many American doctors. Their combined reporting and analysis concentrates on the human aspects of this disturbing trend in health care, with personal experiences that reflect poorly on hospitals as well as physicians. They show how money spent for questionable and even useless care is diverting major funds that could be better used to treat patients who are genuinely sick and sometimes cannot afford the extravagant charges of the American health-care system. Their suggestions for reforming the delivery of health care, and their cautions to individual consumers about how to deal with situations they may encounter, make The Treatment Trap essential reading for medical care consumers, health-care professionals, and policymakers alike.

Editorial Reviews

Booklist
Grants program director Gibson and World Bank economist Singh present a riveting case against the “more” culture of American medicine that is a natural development of the ideology that fueled the nation’s settlement and frontier expansion but that, applied to health care, facilitates alarming results. When emphasis shifts from scientifically weighing risk against patients’ potential medical benefit to maximizing health-care professionals’ profits, consumers pay more for often unnecessary tests, treatments, and procedures, and they and the system suffer. Medical overuse occurs because it can. Doctors’ autonomy within “a self-sealed system” keeps scrutiny at bay, leading to the overemphasis of dire prognoses and the domino effects of extra testing despite the increased likelihood of false positives and NIH warnings about the carcinogenicity of X-rays. And the affects of medical overuse for the sake of money aren’t only physical. A disproportionately frightening diagnosis “changes your view of your body and your life,” one research scientist says. Including an appendix of “Twenty Smart Ways to Protect Yourself,” this compelling argument may attract plenty of attention.
CHOICE
This book exposes medical hucksterism and debunks the myth that more is better.... Recommended.
More Reviews (5) Fewer Reviews
Health Affairs
Through a series of compelling stories in their readable book, Gibson and Singh show the effect of too much doctoring, including some stories that show assertive patients rejecting treatments they believed to be unnecessary.
Oncology Times
The Treatment Trap is beautifully written—clear and direct, filled with facts bookended by stories of people caught and harmed by the system and the doctors they had trusted completely....The Treatment Trap is the canary in the mine for the medical profession.
The Washington Post
The Treatment Trap" is co-authored by Rosemary Gibson, who long worked at the Robert Wood Johnson Foundation on health-care quality and safety issues, and by Janardan Prad Singh, an economist at the World Bank whose previous work has concentrated on the same area. Together, they have produced a well-told, well-researched catalog of horrors about people killed and maimed by tests and operations they didn't need. Theirs is not the first popular account of the dangers of over-treatment, but it updates a story that cannot be told often enough, and in a way that can serve as a useful consumer guide to anyone contemplating a course of treatment. Good to know, for example, that one-third of all heart bypass surgeries are unnecessary or that there is virtually no evidence to support surgery for back pain. The authors are particularly effective in pointing out that much going on in the name of prevention and diagnosis is wasteful or harmful. ....The secrets we keep in health care, whether it's the results of drug company tests that failed or all the data contained in lost and scattered paper medical records, come at a great cost to medical progress.
Library Journal
Gibson and Singh (coauthors, Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions) take aim concisely at a problem they believe threatens the health-care system no matter what form it may take. Citing both scholarly studies and anecdotal evidence, they describe a world of excessive testing and treatment too often based on little or no evidence and driven by the scramble for profits. At the root of much of this is the fee-for-service system, which pays physicians and hospitals for quantity over quality and efficiency. The victims are patients, who may find themselves dangerously overtreated, as well as everyone who in one way or another pays for the unnecessary testing and treatment, expensive new equipment, and drugs. The authors include a list of tips to avoid overtreatment and broader suggestions for changing the system. VERDICT Consumer oriented and clearly written, this should prove useful as people increasingly take a more critical look at what health-care providers recommend.—Dick Maxwell, Porter Adventist Hosp. Lib., Denver
Publishers Weekly
Here’s a book that might do more than health reform to get readers to question doctors’ recommendations for medical procedures. Gibson and Singh, who together broached the subject earlier in Wall of Silence, offer tales of patients who have been horrifically—sometimes fatally—ill-advised by doctors to have unnecessary medical procedures with unexpected complications. One man went for knee replacement surgery to ease his aching legs and died of a heart attack; a fireman was subjected to unnecessary heart bypass surgery; and a South Carolina teen died from complications of an unsafe but slickly marketed new procedure for a mild case of a condition called funnel chest. These cases are numerous and shocking. The solutions are less obvious. The authors cite experts who say the problem is systemic—doctors get paid for procedures—but suggest that patients can protect themselves by becoming informed consumers. The authors offer no roadmap through the maze of medical decision making, but these warnings are a welcome guide in a process that too often depends on a patient’s leap of faith. (Mar.)

Product Details

  • ISBN-13: 9781566638425
  • Publisher: Dee, Ivan R. Publisher
  • Publication date: 4/9/2010
  • Pages: 240
  • Sales rank: 1,191,388
  • Product dimensions: 5.60 (w) x 8.60 (h) x 1.10 (d)

Meet the Author

Rosemary Gibson is senior program officer at the Robert Wood Johnson Foundation, where for thirteen years she has directed hundreds of millions of dollars in grants aimed at improving end-of-life care. Janardan P. Singh is an economist at the World Bank and has written extensively on health care, social policy, and economic development. The authors have also collaborated on Wall of Silence, a book of narratives about medical error.

First Chapter

The Treatment Trap

By Rosemary Gibson

Ivan R. Dee

Copyright © 2010 Rosemary Gibson
All right reserved.
ISBN: 978-1-56663-842-5

Chapter One

VOICES IN THE WILDERNESS

IT WAS 1998, and the truth was coming out. In Washington, D.C., the Institute of Medicine of the National Academy of Sciences convened a prestigious group of physicians, nurses, and consumers who acknowledged a uniquely American characteristic of our healthcare system. They called the phenomenon "overuse" and said it occurs when the potential for harm of a health-care service exceeds the possible benefit.

What exactly is overuse? It happens when people have surgery even though their medical condition does not warrant it. It is the revolving door of seemingly benign yet unnecessary tests and office visits that can stir an avalanche of still more tests and procedures. It is the rendering of treatment when no evidence exists that it will yield a benefit.

The phenomenon began to be noticed in the 1970s when Dr. John Wennberg, a physician and pioneer in research on differences in health-care use among communities around the country, observed an epidemic of tonsillectomies in Vermont. His research showed that in the town of Stowe, 70 percent of the children had their tonsils removed by the time they were fifteen years old, compared with only 20 percent of children in Waterbury. Wennberg wrote, "For half a century, the tonsil has been the target of a large-scale, uncontrolled surgical experiment-tonsillectomy."

Wennberg discovered another epidemic, affecting men in Maine. Sixty percent of men who lived in certain communities had their prostates removed by the time they were age eighty, while only 20 percent of men had the surgery if they lived elsewhere in the state.

In the U.S. Congress in 1974 the House Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Experts testified that nearly 18 percent of surgeries they studied might not have been necessary. In 1976 a House Subcommittee on Oversight and Investigations heard evidence and concluded that 2.4 million unnecessary surgeries were performed annually, resulting in 11,900 deaths. The annual cost of these surgeries was estimated at $3.9 billion. Since 1976, no new estimate of overuse has been calculated.

In the 1980s and 1990s the Rand Corporation and other researchers studied the overuse of selected medical procedures and found that many people had surgeries and tests they did not need. One of the procedures they examined was endoscopy, a most unpleasant examination in which the patient swallows a thin, flexible, lighted tube, called an endoscope, which then transmits a picture of the esophagus and stomach from the inside. Seventeen percent of endoscopies were performed for clearly inappropriate reasons.

The term "overuse" was first coined in 1991 by Dr. Mark Chassin, a physician and researcher, and now president of the Joint Commission, the Chicago-based organization that accredits and certifies sixteen thousand health-care organizations. In an article in the Journal of the American Medical Association, he defined it as providing a treatment when its risk of harm exceeds its potential benefit. At last a growing phenomenon in American health care had a name.

Although there was ample evidence of too much medicine, it did not arouse concern among the public, the medical establishment, or policymakers. "I feel as if I am a voice in the wilderness," says Dr. James Weinstein of Dartmouth, who has conducted extensive research on unnecessary back surgery. "There's a Latin phrase for it, 'Vox clamantis in deserto,' a voice shouting in the desert or wilderness."

OVERUSE COMES OUT OF THE CLOSET

In recent years, however, overuse has gained media attention. A Wall Street Journal front-page headline reported new studies that "hint at overuse" of stents to open clogged arteries. The New York Times reported on Elyria, Ohio, where the number of angioplasty procedures performed to open clogged arteries was four times the national average.

When Jane Brody, the veteran personal health columnist for the Times, described her painful experience with knee surgery, an orthopedic surgeon responded that his boss at his hospital complained that he didn't perform enough surgeries to bring in sufficient revenue. Brody wrote, "This is outrageous and just reveals the monetary motivation behind much of modern medicine. The patient be damned; just bring in the bucks."

Local newspapers provide a hometown flavor about overuse. In Hilton Head, South Carolina, the Island Packet reported on a whistle-blower lawsuit filed by a physician at Hilton Head Regional Medical Center accusing a physician colleague of performing hundreds of unnecessary heart catheterizations. The accused physician reportedly fled the country, possibly to Canada or Saudi Arabia.

The Miami Herald reported on a whistle-blower case brought by an anesthesiologist in which a neurosurgeon was prosecuted by the U.S. attorney for performing more than 150 unnecessary back surgeries. The Minot (North Dakota) Daily News described a lawsuit filed by a woman who accused a physician of performing an unnecessary lung surgery. That same month the Victoria (Texas) Advocate published an article, "Are Doctors' Morals for Sale?" quoting local doctors who claimed that their peers were performing excessive and needless tests and procedures "simply to make a buck." The newspaper alleged that "insured Victorians are being fleeced."

Consumer advocacy organizations have joined the voices in the wilderness to forge a path toward a more reasonable use of medical care. Debra Ness, president of the National Partnership for Women and Families, a Washington, D.C.-based nonprofit group that advocates for better health care, told a U.S. Senate committee, "Unnecessary care is rampant."

What lies beneath the news reports, congressional testimony, and health statistics? What happens to the people? A closer look reveals the untold human story.

(Continues...)


Excerpted from The Treatment Trap by Rosemary Gibson Copyright © 2010 by Rosemary Gibson. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Sort by: Showing all of 2 Customer Reviews

  • Anonymous

    Posted May 14, 2010

    I Also Recommend:

    9780982696507

    Scary

    After reading this book, I am scared to go the doctors. Very interesting story though. I think anyone who has several medical problems should read this book before going to the doctors and getting admitted to the hospital

    Was this review helpful? Yes  NoThank you for your feedback.   Report this reviewThank you, this review has been flagged.

  • Posted February 2, 2010

    I Also Recommend:

    9780895261120

    Essential reading before facing a medical decision

    Rosemary Gibson tells a difficult message with clarity and ease. The overuse of tests, treatments, and surgeries is a whispered phenomenon that is brought to light by professionals and patients in this easy to read book. Interspersing personal stories with just enough research and data allows any reader to get a handle on the pressing issue of the overuse of medical care. The final chapters give a roadmap for activists and consumers to address the challenges we face in medical decision making. Thank you Rosemary for bringing us the stories to underscore the problem.

    Was this review helpful? Yes  NoThank you for your feedback.   Report this reviewThank you, this review has been flagged.
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