A bombshell of a book: must reading for consumers, their political representatives and all those White House contenders.
Journalist Brownlee blames America’s sky-high healthcare costs on expensive treatments imposed by doctors on patients all too ready to accept or even demand them.
At a time when presidential candidates are asked how they plan to pay for universal healthcare coverage, the author provides reams of data to back up her contention that the real issue is the “dysfunctional, unfair and spectacularly expensive system” we’re already paying for. Unnecessary care is rampant, she concludes. Doctors are coaxed, conditioned or warned that they must prescribe drugs or tests, refer to specialists, put patients in the hospital, operate. If this excessively aggressive approach involves a new drug, device or machine, so much the better: Medicare or another insurer will pay generously for high-ticket items, but not for prevention and advice. Some patients benefit; many do not. Medicare patients living in high-cost, high-care regions are no healthier than their peers in lower-cost, less-care regions. For this conclusion, as for others in the book, Brownlee relies on data from the Dartmouth Atlas of Health Care, an annual compendium that tallies who gets what procedure for what ailment in each region of the country. Overtreatment is a national problem, the author states. Precipitating factors include aggressive physicians; litigious patients ready to sue over any omission; and hospital administrators adding (and filling) surgical wings or ICUs to pay for emergency departments that operate at a loss. Also contributing to the mess are direct advertising to consumers and control of clinical trials by Big Pharma, insufficiently monitored by weak federal agencies charged with regulation and with reviewing the evidence of what works. What to do? Brownlee points to the Veterans Health Administration, which rose from rock bottom in the mid-1990s to become a model health-care provider. Other institutions could achieve similar results, she believes, by implementing a strategy of “CARE”: coordination, accountability, electronic medical records and evidence.
A bombshell of a book: must reading for consumers, their political representatives and all those White House contenders.Pub Date: Sept. 1, 2007
ISBN: 978-1-58234-580-2
Page Count: 320
Publisher: Bloomsbury
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: July 1, 2007
For Howard Zinn, long-time civil rights and anti-war activist, history and ideology have a lot in common. Since he thinks that everything is in someone's interest, the historian—Zinn posits—has to figure out whose interests he or she is defining/defending/reconstructing (hence one of his previous books, The Politics of History). Zinn has no doubts about where he stands in this "people's history": "it is a history disrespectful of governments and respectful of people's movements of resistance." So what we get here, instead of the usual survey of wars, presidents, and institutions, is a survey of the usual rebellions, strikes, and protest movements. Zinn starts out by depicting the arrival of Columbus in North America from the standpoint of the Indians (which amounts to their standpoint as constructed from the observations of the Europeans); and, after easily establishing the cultural disharmony that ensued, he goes on to the importation of slaves into the colonies. Add the laborers and indentured servants that followed, plus women and later immigrants, and you have Zinn's amorphous constituency. To hear Zinn tell it, all anyone did in America at any time was to oppress or be oppressed; and so he obscures as much as his hated mainstream historical foes do—only in Zinn's case there is that absurd presumption that virtually everything that came to pass was the work of ruling-class planning: this amounts to one great indictment for conspiracy. Despite surface similarities, this is not a social history, since we get no sense of the fabric of life. Instead of negating the one-sided histories he detests, Zinn has merely reversed the image; the distortion remains.
Pub Date: Jan. 1, 1979
ISBN: 0061965588
Page Count: 772
Publisher: Harper & Row
Review Posted Online: May 26, 2012
Kirkus Reviews Issue: Jan. 1, 1979
BOOK REVIEW
BOOK REVIEW
BOOK REVIEW
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
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