More than Medicine
The Broken Promise of American Health
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- $29.99
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- $29.99
Publisher Description
Stanford’s pioneering behavioral scientist draws on a lifetime of research and experience guiding the NIH to make the case that America needs to radically rethink its approach to health care if it wants to stop overspending and overprescribing and improve people’s lives.
American science produces the best—and most expensive—medical treatments in the world. Yet U.S. citizens lag behind their global peers in life expectancy and quality of life. Robert Kaplan brings together extensive data to make the case that health care priorities in the United States are sorely misplaced. America’s medical system is invested in attacking disease, but not in addressing the social, behavioral, and environmental problems that engender disease in the first place. Medicine is important, but many Americans act as though it were all important.
The United States stakes much of its health funding on the promise of high-tech diagnostics and miracle treatments, while ignoring strong evidence that many of the most significant pathways to health are nonmedical. Americans spend millions on drugs for high cholesterol, which increase life expectancy by only six to eight months on average. But they underfund education, which might extend life expectancy by as much as twelve years. Wars on infectious disease have paid off, but clinical trials for chronic conditions—costing billions—rarely confirm that new treatments extend life. Meanwhile, the National Institutes of Health spends just 3 percent of its budget on research on the social and behavioral determinants of health, even though these factors account for 50 percent of premature deaths.
America’s failure to take prevention seriously costs lives. More than Medicine argues that we need a shakeup in how we invest resources, and it offers a bold new vision for longer, healthier living.
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Kaplan, director of research at the Stanford School of Medicine Clinical Excellence Research Center, argues the U.S. health care system is failing because "we measure the wrong things," like cholesterol and other biomarkers, rather than focusing on overall wellness. Now "deeply invested" in expensive biomedical research, the U.S. spends more on health services than other developed nations $3.2 trillion in 2017 yet Americans have shorter life expectancies and higher infant mortality rates than the populations of those countries. Kaplan blames overinvestment in "moonshot" medicine the Human Genome Project, for example, and the National Children's Study approved during the Clinton administration as well as stem cell and gene therapy research, noting that "by 2012, more than 1,800 gene therapy trials were ongoing, but no cures had materialized." Kaplan attempts too broad a critique of the health-care system, branching out into discussions of the flaws of peer review research, the problems with medical clinical trials, and diagnostic errors among physicians. Nonetheless, Kaplan's call to "rethink" how health-care costs could be lowered through greater attention to disease prevention and social and behavioral risk factors is worth noting.