45 internautes sur 46 ont trouvé ce commentaire utile
- Publié sur Amazon.com
Dr. Andrew Weil doesn't mince words; he joins the health care reform fray with a "radical" point of view: "Most commentators assume that the root problems are (a) how to give more people access to the present system and (b) how to pay for it. I strongly disagree." In recent weeks Weil has appeared on CNN, written articles (Google for them), and, now, released a new book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future, urging a fundamental shift from "high-tech" to "high-touch." He makes the persuasive case that our accelerating reliance on expensive medical technology and medicine have contributed greatly to ballooning health care costs: on page 70 of the book, he lists 1950 costs of U.S. care at $8 billion, 1980 costs at $212 billion, and 2009 costs at $2.5 trillion (with a T). He also estimates future costs in 2015 at $4 trillion. Even adjusting for general economic inflation and related factors, these are staggering increases that amount to one-sixth of earnings presently (p. 123). Weil insists that for this reason, "high-tech disease intervention...is obsolete." He wants less reliance on expensive pharmaceuticals, scans, surgeries, specialist ,hospital stays; and more emphasis on integrative medicine which treats patients not just for isolated symptoms but as whole persons. He wants the general practitioner to make a comeback. He wants doctors who will take personally take lengthy histories, listen carefully, recommend dietary modifications, offer exercises for stress relief, refer to practitioners of Chinese or chiropractic medicine if appropriate, etc. He says, frankly and convincingly, that continuing high-tech is simply unsustainable.
Weil also is a staunch supporter of universal health care with single payer. He believes the federal government should take a very active role in many aspects of health care. For instance, he proposes a federal mandate requiring doctors to have, at minimum, a one-hour initial consultation with a new patient. He also desires that government create several more health agencies, and he supports a "national system of electronic medical records" with privacy guarantees (although he makes no mention of how privacy would be achieved). He wants a legislative ban on "direct-to-consumer advertising of prescription drugs." In fact, Weil says, "It is imperative that the pharmaceutical drug industry be drastically reformed by increased governmental oversight" and other pressure. He says malpractice reform could save "as much as 10%." He is also insistent that for-profit health insurance companies and hospitals need to be phased out: hospitals ought to be non-profit, and private insurance companies shouldn't exist.
In general, the blueprint Weil details in WHY OUR HEALTH CARE MATTERS is focused and visionary, both qualities very valuable to the current, heated health care debate in our country. At times though, Weil adopts seemingly contradictory views. He, for example, strongly lauds individual responsibility for personal health and reminds us that Americans used to pay most medical costs out of pocket instead of relying on Medicare, Medicaid, private insurance, etc. His point, in part, is that when we only pay a co-pay for a doctor's visit, we may go more than if we had to pay it all directly ourselves. Yet, as mentioned, he also advocates universal health care with everyone being insured, basically, by the government, and he wants to expand the health services which would be covered. Such a universal system could invite less individual responsibility regarding costs of procedures and services. In a sense, these contradictions are simply an indicator of the sheer complexity of health care issues. Even when a knowledgeable, experienced M.D. seeks to lay out a comprehensive reform plan, not everything fits together. This can help remind us all that there are no easy answers, and we should all question everything anyone says about health care reform.
One does not have to agree with all of the proposals in WHY OUR HEALTH CARE MATTERS to find this an instructive and important contribution to the debate. Weil arguably places too much trust in the abilities and powers of government, and not enough in the ability of private enterprise to be flexible under changing conditions. And one can argue that his aims are too utopian (or just too overreaching). But his clarion call that "we must stop paying for failure" in our health care system is advice best heard. His new book is one every American ought to read and then contact their legislators about implementing those portions of it with which they do agree. (4.5 stars)
14 internautes sur 14 ont trouvé ce commentaire utile
- Publié sur Amazon.com
The hard truth, a truth that Dr. Weil communicates expertly, is that America is NOT #1 when it comes to health care. We may spend the most, but as the book states, if any other industry performed as poorly and cost this much, we would have stopped throwing money at it years ago. It is difficult for free enterprise to function properly when the product being offered may mean life or death. This is where the system breaks down.
I am not going to quote the whole book, I'm note even going to rattle off some of the very disturbing statistics of just how horrible a shape we're in. I am going to say that Dr. Weil makes a fair and informed argument for his idea of change, praising the areas where we excel and pointing out the areas of grave failure. While everyone is arguing about how to give more people access to the system, Dr. Weil draws attention to the root of the problem, the system itself.
His ideas are not so radical. They are old ideas, applied to a new era of medicine. We've lost a lot of what made our doctors great, what made them proud of their jobs and their roles in our communities. The trillion dollar industries of health insurance, pharmaceuticals, and medical technologies have distorted our views of what is beneficial, appropriate, and necessary when it comes to our health. High-tech health care has its place, but we also need to take responsibility for our lifestyles and not rely on a pill or surgery to fix the problems we created by our own choices. They don't always work.
Awareness must come first, before the solutions. Reading this book certainly helped me realize that our health care crisis is going to go from bad to worse in short order if this country doesn't make a major course correction. It starts with me, my health, my choices, and whether or not you agree with Dr. Weil's plan for America, my hope is that it makes you examine your own life and decide that your health DOES matter.
31 internautes sur 36 ont trouvé ce commentaire utile
- Publié sur Amazon.com
This is the most timely and essential book you will ever read.
Andrew Weil has the right diagnosis and the right cure for what ails America-- he helps you understand why so many people have health problems and crippling health costs, despite the myth that America is number one in health. (Hint-- our real rank in health status is way down the list with the Serbians!)
This book answers every single question about why the health of US citizens is worse (and more costly) than that of folks in all other developed nations.
In a clear, thoughtful, readable and no-nonsense way, Weil assesses what works and what doesn't work in US health care, and proposes the major changes we need to get health care right in this country.
For health information and action, get the free ezine the Health Outlook at [...]
10 internautes sur 11 ont trouvé ce commentaire utile
John R. Sedivy
- Publié sur Amazon.com
"Why Our Health Matters" is not your typical health book. It addresses the author's style of treatment called Integrative Medicine (IM) which is a blend of conventional and whole body treatment. What I really enjoyed about this book was the conversational tone and approachable style - despite the author's Harvard education and decades of medical practice, he has still made the subject matter easy to understand and engaging.
This book is political to some extent and addresses his view on the need for expanding IM on the national scene by means of a combination grass roots and national health plan - a very timely and relevant discussion. Whether you agree or disagree with the author's viewpoint and policy discussions, he does provide compelling and well thought out arguments.
Overall the author states that the system is broken due to a focus on disease management and high technology - which are both costly and unsustainable. Dr. Weil proposes that healthcare should focus on preventative medicine and personal, localized treatment. In addition to these ideas there are some good health tips thrown in for good measure.
I recommend this book for those interested in the national healthcare debate, forward thinking medical philosophies, and health tips. At a minimum this book will get you thinking about your health and areas which contribute to your well-being. This is the first book I have read of Dr. Weil's, however I plan on reading the others having enjoyed "Why Our Health Matters."
9 internautes sur 11 ont trouvé ce commentaire utile
Loyd E. Eskildson
- Publié sur Amazon.com
Dr. Weil begins by telling us that we do not have a 'health-care' system, but a horribly dysfunctional disease management system, with the highest percentage of uninsured citizens of any democratic society. The average American family's premiums not exceed the gross annual income of a full-time minimum wage worker. Medical care costs are now the leading cause of bankruptcy. Yet, by almost every measure of health outcomes we are at or near the bottom compared to other developed countries. As a result, we are beginning to see a trend towards outsourcing care to other countries.
"Why Our Health Matters" tells how both personal health and the nation's economic health can be improved through changing how health care is delivered in America. Dr. Weil's objectives in writing this book: 1)Change the focus from disease management to prevention and health promotion. 2)Minimize dependence on expensive technology.
Dr. Weil is quite negative on for-profit health care, and relatively new phenomena, but endorses expanding Medicare to cover all patients in the U.S. He believes the greatest cost savings we can achieve will come from limiting the use of expensive diagnostic and therapeutic methods to the most severe cases where they are clearly indicated, and instead focus on nutrition and behavioral changes for the rest.
Example: A major randomized clinical trial (RCT) found that angioplasties and stents do not significantly prolong life or even prevent heart attacks in stable patients (i.e., in most patients who receive them). Conversely, studies by Dr. Dean Ornish showed that people with severe coronary heart disease were able to stop or reverse it by making intensive lifestyle changes, without drugs or surgery. In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health care costs in those with coronary heart disease by 50% after only one year and by an additional 20-30% in years two and three when compared to a matched control group.
Not only are these more technological approaches more expensive, but also risky and sometimes harmful for patients. (Dr. Weil also suggests that malpractice concerns are part of the problem - reforming malpractice laws might lead to cost reductions of as much as 10%.) Seductive advertising (especially for drugs) also contributes to the problem. Dr. Weil points out that New Zealand is the only other nation that allows this.
Much medical research is worthless - eg. finding new blood pressure medications that are not as good as current (less-profitable) generic products. Dr. Weil also strongly believes that we overemphasize 'Evidence-Based Medicine' (EBM) - that the human body is too complex to be studied through randomized-clinical trials (RCT) , the 'gold-standard' of medicine. Personally, I have problems accepting the author's conclusion in this matter - eg. inadequate drug-company-run RCTs allowed VIOXX to achieve FDA approval, while larger and improved RCTs led to its withdrawal.
"Too many medical specialists" is another of the author's concerns. (Radiologists earn up to $900,000+, vs. G.P.s at $175,000. Clearly that has motivated some hospitals to outsource reading X-rays etc. and the development of software to help interpret results.) Dramatic new treatments for blocked coronary arteries, etc. tend to decrease the motivation to improve one's personal habits; utilizing those new treatments is also far more remunerative for physicians who also often lack training in nutrition and behavioral change therapies. Specifically, increasing obesity (linked to at least 30 illness conditions, though most patients are unaware of its seriousness) is probably the biggest problem physicians, patients, and our health system faces.
Bottom Line: Current rates of cost growth will bring health care to consuming one-third of GDP within ten years. (China now is at about 5%.) Enormous savings are possible. America's major health problem is chronic degenerative diseases (heart disease, diabetes, prostate/breast cancer, and obesity) - accounting for 75% of spending. Again, Dr. Ornish's writings reinforce Dr. Weil's: A recently reported European study (8/10-24/2009 Archives of Internal Medicine) found that in 23,000 people adhering to 4 simple behaviors (not smoking, exercising 3.5 hours a week, eating a healthy diet including fruits, vegetables, beans, whole grains, nuts, seeds, and low meat consumption, and keeping a healthy weight) that 93 percent of diabetes, 81 percent of heart attacks, 50 percent of strokes and 36 percent of all cancers could be prevented. In addition, there are also substantial treatment savings possible, per Dr. Weil, and Medicare studies that have found some areas spending 2X that of others, with no clear difference on outcomes.