On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.103 n.3 Cape Town Mar. 2013
Rethinking Aging: Growing Old and Living Well in an Overtreated Society
By Nortin M Hadler. Cape Town: UCT Press. 2011. ISBN 978-1-92049-996-9.
Defensive (and aggressive) medicine has led to the USA leading the world in the cost per capita of its medical care. In many aspects it leads the world in quality of care. Hadler, however, takes us through convincing evidence of the harms of overtreatment to individuals and society, and cost is by no means the only factor.
He challenges many beliefs that have become standard medical practice and advice on diverse topics such as weight (it's OK to be overweight - but not obese), exercise, diet and lifestyle. The use of statins, treatment of hypertension, coronary artery disease interventions, treatment of type 2 diabetes and many others come in for heavy criticism: commonly prescribed drugs, such as beta blockers, ACE inhibitors, and statins, are testimony to the American philosophy of "don't just stand there, do something," rather than evidence-based, informed medical decision making'. Of screening tests (including breast, prostate and colon cancers) he concludes: 'unconscionable amount of overdiagnosis and overtreatment for such tenuous benefit'. He deals with 'the proclivity of American physicians to get imaging studies and the expectation of the American patient to be studied and to receive a "you're normal" report'. Hadler criticises what this has done to medical education and fears that medical practitioners, for financial and other reasons, are obliged to practise in this way.
While this book is based on medical practice in the USA, the themes are applicable in private medicine in South Africa (and, to a lesser extent, in the public sector). Hadler's compelling analysis of research is a sobering read for practitioners who may have become complacent and unquestioning in their practices, although some would accuse him of confirmation bias in his choice of literature and arguments.
This is an excellent book on ageing and the pitfalls of overdiagnosis and overtreatment, and is recommended to both health professionals and the lay public.
J P van Niekerk