New book: Rethinking Aging: Growing old and living well in an overtreated society
Overtreatment—the theme of this website—is getting much more attention in medical journals these days, but does the public understand? After all, we are the recipients (victims?) of overly aggressive or unnecessary medical treatment. In a survey, published recently in the Archives of Internal Medicine, nearly half of U.S. primary care physicians said they thought their patients were overtreated; only 6% thought their patients received too little care.
But who will tell the people? And how will they recognize inappropriate treatment? One answer is the latest book by Notrin M. Hadler, MD, author of Rethinking Aging: Growing old and living well in an overtreated society. An author of several books revealing the inadequate science behind many standard medical treatments, Hadler now trains his informed skeptic’s eye on medical care of the elderly. Aging, you may have noticed, has become a disease in need of drug treatment. I’m with those who say it all started decades ago when—with strong behind-the-scenes drug-industry backing—menopause became a hormone-deficiency disease in need of long-term hormone therapy.
Hadler, professor of medicine and microbiology/immunology at University of North Caroline, Chapel Hill, makes it clear that this is not “a textbook of geriatrics for the lay reader” nor does it provide the latest tips for successful aging (we get enough of that from the AARP Bulletin). He tells why and how we should be cautious about allowing ourselves to be tested, especially when no symptoms are present. Testing healthy low-risk people leads to overdiagnosis which in turn puts them on the proverbial conveyor belt to overtreatment.
Drugs are approved on the basis of what researchers call “surrogate endpoints”, Hadler states, and the research is conducted and spun by the drug companies to make us think that is the goal. Put another way: Just because a drug makes dramatic improvements in risk factors like high blood pressure, cholesterol or bone loss (surrogate endpoints), don’t assume that these drugs are also making dramatic reductions in your chances of having a heart attack, stroke, or hip fracture. The reality is far more modest, and risks usually go unmentioned, downplayed, or not discovered until years later.
“Treating high cholesterol in older well people is unconscionable,” writes Hadler, who sees this as part of a far larger problem. “So many medicines prescribed for the elderly target long-term risks and hazards rather than active illness.”
There is, of course, a multi-billion-dollar pharmaceutical industry that conducts the studies of its own products; cherry-picks findings that are favorable; routinely withholds serious adverse effects data; “educates” our doctors, defines illness, and cashes in handsomely whenever long-term drug therapy is prescribed to healthy people (sick people have the unfortunate likelihood of dying earlier). No wonder, for example, that the overwhelming majority of Americans taking one of the blockbuster cholesterol-lowering statin drugs are healthy people without heart disease.
Then there are the expanding definitions of “abnormal”. I’ve kept my health form from 1992 when it was required for an Outward Bound whitewater rafting trip. Under the line for blood pressure, the form instructs the examining doctor to repeat the measurement “If BP is over 150/90.” Today, the instruction would be, “Repeat if over 120/80”, currently the latest definition of high BP. Hadler points out that there’s no evidence that drugs given to bring BP below 140/90 will benefit anyone.
I’ve often wondered why I would occasionally read in medical journals that normal aging brings a steady rise in the upper BP number (systolic pressure) until people reach their eighties; yet this is never reflected in the treatment recommendations from influential organizations like the American Heart Association. Hadler takes this on: “It would be abnormal if the systolic-diastolic difference didn’t widen in our Golden Years,” he writes, going on to explain the complexities that should drive the decision to treat BP, rather than a one-size-fits-all approach.
Then there’s diabetes 2, yet-another disease with an expanded definition that has made millions of healthy people into long-term drug customers. Oral hypoglycemic drugs were introduced in the 1950s, which made sense, says Hadler, because they normalized blood sugar metabolism. “But sense did not hold up to scientific testing,” he notes when the practice was finally—in the 1970s—subjected to a randomized controlled trial, compared oral hypoglycemic to diet or insulin therapy.
“The study participants treated with the early version of an oral hypoglycemic did worse than those in the other two groups, including more deaths. I never again prescribed any oral hypoglycemic, and vowed I wouldn’t until there was data that these agents were beneficial to my patients, not just effective in normalizing their glucose metabolism.” In the intervening decades, no studies have produced such evidence, according to Hadler.
I can’t leave you without naming a few other topics addressed in this book: It’ s OK to be overweight. Longevity is not heritable. We’re meant to live only to 85, after that, things will most likely go downhill. Alzheimer’s disease testing is not ready for prime time, most vitamin D and calcium supplementation is a waste of money … and much, much more.
Maryann Napoli, Center for Medical Consumers©
Related articles:
Overdiagnosed—Making people sick in the pursuit of health
Another doctor-authored book on the the topic published early this year.
Just say no
Primary care physicians name the most useless tests and treatments frequently administered by their peers.
No benefit to reducing blood pressure below 140/90
A review of all relevant studies from the Cochrane Collaboration.
Overtreated—Why too much medicine is making us sicker and poorer
Earliest book on the topic. This one by an investigative journalist.
Center for Medical Consumers 