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Book and Media Reviews
October 22 2008

Worried Sick

JAMA. 2008;300(16):1943-1950. doi:10.1001/jama.2008.521

Nortin Hadler takes very seriously the Hippocratic concept that medical care should deliver more good than harm. In Worried Sick, he makes the case that much of medical care does not meet that standard.

Those paying for medical care—health insurance companies, employers, taxpayers—should welcome the counsel that Hadler provides to his patients. To the extent that patients heed his counsel, they would (1) receive almost no coronary artery stents or angioplasties and only consider having coronary artery bypass graft surgery if they had significant left main coronary artery occlusion; (2) receive virtually no spinal fusions and be very conservative about seeking any surgical interventions for spinal discomfort; (3) have no colonoscopies to screen for colorectal cancer, have no prostate-specific antigen tests to screen for prostate cancer (thereby avoiding most of the radiation and surgical procedures performed for cancers that would never have become evident), and undergo only select mammograms (thereby avoiding the biopsies that go with false-positive mammogram results); and (4) would not take statins to lower their cholesterol levels unless they had a diagnosis of or a high risk for coronary artery disease; likewise, except for those older than 65 years, who might get a diuretic, they would not take medications to moderately lower elevated blood pressure.

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