Worried Sick: A Prescription for Health in an Overtreated America

If you want to save yourself from being labeled as having a disease you don't have and take medications you don't need, then you must read Worried Sick: A Prescription for Health in an Overtreated America by Nortin Hadler, MD.

Dr. Hadler is a graduate of Harvard Medical School, a professor of medicine at the University of North Carolina at Chapel Hill, and the author of 15 books and 200 medical papers. He is a frequent reviewer and editorial writer for the New England Journal of Medicine, the Journal of the American Medical Association, and other publications. He is also a regular contributor to ABC News. You can read his articles at abcnews.com.

In Worried Sick, Dr. Hadler examines many common diagnoses and treatments, and he questions their validity and scientific basis. He shows clearly that many diagnoses and treatments are not based on science, that treatments can be of questionable value, and that some treatments might be harmful.

Here's the review of Worried Sick from the May, 8, 2008, issue of the New England Journal of Medicine:

"Hadler, a rheumatologist and occupational medicine specialist, concentrates on medical decisions. He indicts doctors for peddling fake diseases and promising false cures, and he also indicts patients for refusing to accept the normal infirmities of age and the inevitability of death. Like many contrarians, he sometimes overstates his case, but the case is often a strong one."

"Hadler offers a withering critique of the invasive treatment of chronic stable coronary artery disease, echoing the view that has long been advocated by noted cardiologist Bernard Lown. The single-minded focus on opening (or bypassing) narrowed arteries relies on an oversimplified model. Most acute occlusions do not occur at sites with previous high-grade stenoses; stenotic lesions often stimulate the development of collateral circulation that attenuates their danger; and modern medical management often stabilizes plaques. Moreover, randomized trials have shown that few patients with chronic stable angina benefit from mechanical intervention-apart from the 3 percent of patients with left main coronary artery disease."

"Hadler also takes on screening for breast, colon, and prostate cancer, which has not been shown to decrease all-cause mortality but does increase radiation exposure, surgeries, and worry. He criticizes tight glucose control, prefiguring the unexpected results of a recent randomized trial."

The following is a brief overview. For the whole story, read the book.

1. Cholesterol screening: This is a test for which there is no sound scientific basis. In fact, Dr. Hadler has never had his blood cholesterol checked! The statin drugs, such as Lipitor, are of no benefit to a well person. They neither reduce the risk of a heart attack or stroke nor prolong life. Patients who have had a heart attack and then start on Lipitor experience a 2 percent reduction in their risk of having a second heart attack. Taking statins will have a minuscule effect on increasing survival rate after a heart attack. So why should a person who has not had a heart attack take a drug that can cause liver damage and muscle wasting, and reduce an essential enzyme (CoQ10) for heart function?!

2. Type 2 diabetes: Dr. Hadler mentions that an increase in blood glucose level is an expected part of aging, and the effort to regulate blood sugar with medication has shown no effect in terms of preventing damage to the eyes or kidneys, heart disease, or stroke. In fact, ten years of intensive therapy offered no real advantage to 1,000 middle-aged hyperglycemic people (those with a high blood glucose level). Why would anyone want to be on such medication and suffer its side effects without gaining a real benefit? Dr. Hadler argues that changes in diet, weight loss, and exercise are much more effective. Also, what is considered a high blood glucose level? Those levels are set by committees. They are not necessarily based on science; many times, they are based on the influence of pharmaceutical companies. Dr. Hadler proposes that these levels be adjusted for age. A normal blood sugar at age fifty will naturally be higher than for a person at age twenty. And although medications and insulin can help control symptoms, such as excessive thirst and frequent urination, which even people with normal blood sugar may experience, they have not been shown to prevent vascular damage.

3. Hypertension: Dr. Hadler points out that science has not proven that lowering mild high blood pressure can make a real difference in preventing heart disease or damage to organs. He recommends that elderly people who have diabetes and hypertension be treated with medication only if regular exercise, weight loss, and diet modifications do not help. A focus on keeping blood pressure at 120/80 and prescribing medication to those who have blood pressure at 140/90 or greater-but who have no symptoms and are feeling well-is not supported by research. One thing research has shown is that a cheap first-generation diuretic works just as well as the latest (and very expensive) antihypertension drugs. The scientific evidence shows that the elderly with type 2 diabetes and hypertension are the only patients who benefit from medical intervention. I would add to Dr. Hadler's comments that according to the authors of Selling Sickness the risk of a heart attack for a sixty-five year-old man who does not smoke, does not have diabetes, and has blood pressure of 160/90 is 5 percent until age seventy. If he takes blood pressure medication to lower it to 120/80, his risk of having a heart attack by the age of seventy is 4 percent. Is it worth taking a drug every day and suffering its side effects when the benefit is so small?

4. Ruptured disc: Dr. Hadler points out that the concept of a ruptured disc as a cause of back and leg pain was proposed some seventy years ago-and it should have remained there, in the past. There is no evidence that a ruptured disc causes any harm. All the spinal changes due to age detected in an MRI or CT scan are normal. More than 300 randomized studies show that all the treatments of a ruptured disc, ranging from spinal manipulation to shots to surgery, are of no benefit. All studies have shown that patients who refused treatment recovered as well or better than those who were treated. He recommends that patients take steps to relieve the pain and discomfort and get back into their regular routines and work.

5. Knee, shoulder, and hand pain: Dr. Hadler asserts that knee, shoulder, and hand pain should be treated like back pain. The current diagnoses, such as a torn meniscus, a torn rotator cuff, or carpal tunnel syndrome, and conventional treatments for them are of no value. Perhaps the solution is for the patient to take medication for the pain and keep going until recovery.

Hip replacement surgery, according to Dr. Hadler, is the only surgery that is acceptable to relieve joint pain.And even so, pinning the hip is less costly and has a faster recovery rate than hip replacement surgery. However, as John E. Sarno, MD, professor of rehabilitation medicine at New York University, points out in his books The Mindbody Prescription: Healing the Body, Healing the Pain and The Divided Mind: The Epidemic of Mindbody Disorders, hip pain, as well as back, neck, leg, arm, and hand pain, is caused by tension and can be resolved without surgery.

1. Hormone replacement therapy: This treatment is touted as a way of preventing heart disease and osteoporosis in postmenopausal women. Dr. Hadler points out that not only has this treatment failed, but the equipment used for testing the results is not accurate most of the time, and the medications used in hormone replace therapy don't really work. Exercise is a better alternative.

2. Cancer screening: Like Dr. Welch, author of Should I Be Tested for Cancer?, Dr. Hadler finds no scientific basis for the idea that screening well people for cancer has any benefit. He calls it, "looking for a small needle in a big haystack."

There is much more discussed in the book, from fish oil to heart bypass surgery, that you'll need to read for yourself. Unfortunately, we are dealing with a medical system that ignores science and is heavily influenced by pharmaceutical companies. Physician and health educators like Dr. Hadler provide a great service.

Here's the Amazon link for Worried Sick.

Another excellent book on this topic is Overdiagnosed: Making People Sick in the Pursuit of Health by Dr. H. Gilbert Welch, Dr. Lisa Schwartz, and Dr. Steve Woloshin.

It's good to see that there are still doctors out there who are willing to stand up to the pharmaceutical industry and put the welfare of their patients first.

Stay informed. Stay well.

Fred Amir