Unhealthy medicine

Doctor says much modern health care may not be doing any good

This book begins at the end. The end being your death at about age 85. No matter what you do, no matter how many miles you jog or how many vitamins you take or how many doctors you consult, one day the grim reaper will knock on your door. The question "Worried Sick: A Prescription for Health in an Overtreated America" aims to answer is how to get to your four score and five. Surprisingly, it argues against relying on many of the accepted practices of modern American medicine.

The author of this iconoclastic tract, Nortin Hadler, is a medical professor and practicing rheumatologist at UNC-Chapel Hill. His book is certain to stir up controversy among his colleagues and will likely raise a few hackles. His writing style may raise some hackles, too. It is loaded with complicated sentences that don't exactly roll off the tongue. Here's an example: "It was postulated that a particular clinical presentation was so likely to eventuate in cardiovascular disaster that it deserved denoting as a syndrome." Despite this over-the-top style, Hadler manages to get his message across.

He begins by examining common treatments for heart disease. Inserting stents in clogged arteries and coronary artery bypass surgery are the biggest guns in the cardiologists' armory. Both procedures are expensive and ineffective, according to Hadler. Neither has been shown to prolong life except in one particular form of heart disease. Both procedures, he asserts, "should be consigned to the annals of good ideas that proved bad."

He follows that startling conclusion with a look at another supposed cornerstone of good health, the mammogram, a procedure used to detect early signs of breast cancer. As usual, Hadler doesn't buy it: "The enthusiasm for cancer screening in the United States outstrips reason." Mammography, he proclaims, is a "blunt instrument" that gives false positive readings in more than one-third of the women tested, unnecessarily frightening patients and requiring unneeded biopsies.

Also, he adds, the benefit from regular mammograms is razor thin. Of 1,000 women over the age of 50 in a mammographic screening program, six will die of breast cancer. If those same women skipped mammograms completely, breast cancer would claim the lives of nine. Is the screening worth it? That is a question, Hadler believes, "that should be addressed to every woman before mammograms are ordered."

Hadler takes a similar skeptical tack on many other medical issues. He labels the craze for a diet rich in the omega-3 acids found in fish, for instance, as "much ado about the minuscule." Prostate cancer? "No elderly man should undergo prostate cancer screening." An annual physical examination? "Entirely useless." What about osteopenia, a condition in which the bones become smaller, weaker and more liable to break? Women, in particular, are susceptible to it, and many of them opt for a regular bone mineral density test to detect bone thinning. Hadler will have none of it: "Osteopenia is an example of a New Age social construction, propelled to its status in a decade by aggressive marketing and vested interests."

Are all tests, examinations and medicines useless or, worse yet, harmful? One might get that impression from Hadler's book. He does concede that a daily baby aspirin will help if you have suffered a heart attack. And treating severe cases of high blood pressure with medicines improves life expectancy. But Hadler contends that many standard medical interventions are not risk free and do little to prolong life.

So, what is the layman to make of this? Should we forgo treatment for heart attacks? Skip mammograms and prostate cancer tests?