Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine

Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine

Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine

Diagnosis, Therapy, and Evidence: Conundrums in Modern American Medicine

Synopsis

Employing historical and contemporary data and case studies, the authors also examine tonsillectomy, cancer, heart disease, anxiety, and depression, and identify differences between rhetoric and reality and the weaknesses in diagnosis and treatment.

Excerpt

Americans are besieged by advice about the efficacy of medical therapies and drugs as well as behavioral and dietary modifications that will presumably prevent disease, promote health, and extend longevity. Scarcely a day passes without revelations about new medical breakthroughs that will presumably overcome the ravages of age-old diseases. Faith in medical progress leads the United States to spend far more than any other industrialized nation on its health care system. Yet such health care indicators as longevity, infant mortality, access to care, and the effective management of chronic illnesses lag far behind other nations. Indeed, the claim that the United States has the world’s best health care system belies the facts.

In this book we have collaborated across disciplinary lines and present a series of case studies to illustrate gaps and weaknesses in the medical care system. One of us (Grob) is a medical historian and the other (Horwitz) is a medical sociologist. Both of us, however, share assumptions and beliefs that transcend disciplinary lines, and we have produced an analytic work that hopefully sheds light on a series of contemporary medical issues. We have found that a substantial part of the contemporary literature dealing with therapeutic efficacy, diagnoses, epidemiology, and evidence ignores longitudinal and historical data, to say nothing about methodological inadequacies and claims that rest largely on faith. Our goal in writing this book, however, is not to denigrate the medical care system. It is rather to call attention to some of its weaknesses and exaggerated claims that lead to dubious therapeutic and behavioral interventions and exacerbate the excessive costs of both care and treatment.

We would like to thank William Rothstein, Janet Golden, and Doreen Valentine, who provided valuable suggestions on an earlier draft of the manuscript. Naomi Breslau and Jerry Wakefield made many astute recommendations regarding the ptsd chapter. Part of the material in chapters 2 and 3 is taken from Grob’s “The Rise and Decline of Tonsillectomy in TwentiethCentury America,” Journal of the History of Medicine and Allied Sciences 62 (October 2007): 383–421, and “The Rise of Peptic Ulcer, 1900–1950,” Perspectives in Biology and Medicine 46 (autumn 2003): 550–566. Both are reprinted with the permission of Oxford University Press and the Johns Hopkins . . .

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