|| Medicine Worth Paying For
||Howard S. Frazier and Frederick Mosteller
||Harvard University Press, ©1995
Harvard University Press
79 Garden Street
Cambridge, MA 02138-1423
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
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
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.