Harvard University Press Physicians become important figures when we are sick. We tend to accept authoritative pronouncements and to follow regimens and procedures we are told will make it better. At the same time, we are acutely aware of the cost of health care in our society and the many efforts to control costs. Managed care and the widespread use of HMOs have begun to appear questionable as the vehicle to deliver effective and good quality health care. At the same time, readers of this journal will continue to find physicians accepted as the most authoritative experts in courtrooms. This 311-page book is extremely valuable to all of us who at some time will be consumers of health care and will need to make the best possible decisions we can about our own health. The book is the result of more than 20 years of effort at the Harvard School of Public Health to understand how medicine works and what the health care system actually does. Chapters 1 and 2 provide an historical background for medical treatments and a succinct and cogent description of medical technology and how it is introduced and evaluated. Chapters 3 through 16 summarize the treatments for specific health problems, i.e. measles, diabetes, arthritis, etc., and evaluate their effectiveness and what is known scientifically about the treatment of the problem. In almost every chapter there is an example of a treatment procedure that has been used for many years, but is now known to be ineffective or even potentially harmful. The book is clear and concise in presenting what we need to know in order to understand more about physicians as experts in the courtroom. Medicine has a sociology that is highly responsive to authority rather than scientific information. Consequently, procedures and technologies that are supported by authoritative figures can proliferate and continue even when there is little or no demonstrated benefit. There is a sober and carefully thought out analysis of what needs to be done to improve the delivery of health care and how medical research must be strengthened in order to decrease the frequency of ineffective and costly treatments. The final three chapters offer suggestions for changes in the system that will make it possible for patients to make the best and most informed decisions they can. There is also a discussion of the costs of health care and how it may work best for all of us to understand how to evaluate the costs of health care. Every reader of this journal can benefit greatly from study of this book, both in terms of personal understanding of how to make the best decisions about one's own health and caring for it, and whenever there must be an understanding of the role and the basis for medical opinions in the courtroom. Anybody who is involved in policy development or determination for health care should also read this book and be familiar with its contents. Reviewed by Ralph Underwager, Institute for Psychological Therapies.
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