November 7, 2008

A Book You MUST Read: Hippocrates' Shadow

The only thing wrong with Hippocrates' Shadow: Secrets from the House of Medicine by David H. Newman, M.D. is its title, because it gives you no idea what this insightful book is about. That means a lot of people are going to walk by it who really need to read it.

The title of the book should be Fixing Medicine. The author is an emergency room doctor, someone who has learned to evaluate, diagnose, and treat patients who are minutes from death. In this book, he brings the same swift insight he uses in the ER to sorting out in a mere 214 pages what's wrong with medical practice.

The titles of his chapters say it all: "We Don't Know" discusses the gap between the all-knowing image doctors present to patients and the huge number of conditions they neither understand nor know how to treat.

"It Doesn't Work" describes how doctors continue to use diagnostic techniques and treatments that research has shown to be worthless.

"We Don't Agree" discusses how even well trained doctors can look at the same test results, EKG, or X-ray and come out with completely different diagnoses.

"We Don't Talk" and "We Prefer Tests" are self-explanatory.

The most powerful chapters in the book are the three that come near the end. "We Won't Unlearn" is a devastating look at the way that false "Truths" (he calls them Axioms) become embedded in practice and how doctors cling to them without any idea of where they came from, long after they are discredited by research. We see this all the time with doctors who insist that low fat diets prevent heart disease or nutritionists who tell us that our brains will stop functioning on a low carb diet.

Dr. Newman shows that medical practice is riddled with many more deeply held beliefs that harm patients, beliefs based on findings published in Journals fifty or sixty years ago which have been handed on from doctor to doctor as truth though they were based on flimsy or even made up evidence.

The chapter, "We're Missing the Meaning" explores the concept of placebo and shows how powerful the attitude communicated by a doctor can be in helping or hindering healing. If you don't think that your doctor's (erroneous) belief that you caused your diabetes by being a lazy glutton is having an actual, negative impact on the way your body works, this chapter will change your mind.

Finally, the chapter, "You're a Number" discusses the way that statistics are manipulated to give patients false ideas of risk and benefit. If you read nothing else in this book, you should read this chapter.

In it Dr. Newman explains in simple terms a vital concept:"number needed to treat" (NNT). The NNT is a statistical measure of the actual number of people who will benefit from a drug or treatment. If the NNT is 2 it means that one out of every two people who use the treatment will benefit. This is a very different statistic from "risk" which as he explains is used to magnify an otherwise unimpressive statistical result.

To see the power of this statistic, consider that with statins, if you are not a middle aged male who has already had a heart attack, the NNT is 250. That means one person who takes a statin will not have a heart attack they'd otherwise have had for every 250 people who take it. The other 249 people or their insurers are paying a lot of money for a treatment that will do nothing for them and which may cause devastating side effects.

If you have any interest in understanding the way medicine is currently practiced, you should read the whole book. It will make you better understand why the care you get is so unsatisfying, and in addition it will make you realize that your doctor isn't much happier than you are at having to practice in the current environment.

As I read through this book, I kept wishing that there was some way that well meaning physicians like Dr. Newman could connect with concerned, activist patients like the readers of this blog so we could work together to fix the medical system together. Will that happen? Probably not, but we can always dream.


Rick Darby said...

Thanks for the heads-up, Jenny. I'll look for this book. Your summary fits with what I have long suspected.

I can't blame doctors much. They are hampered by the same system that patients find so frustrating. They're under pressure in most practices to maximize billable hours, just like lawyers, and have little time to read recent experimental literature that might contradict what they were taught in med school or the conventional wisdom in their specialty.

I am a type 2 diabetic, by the way. Thanks for your site.

Anonymous said...

Thanks for the tip.
I'm headed to Amazon this minute.


Anonymous said...

LOL - I think you've caused a run on it, Jenny - only has one left!

Anne said...

Thanks for the recommendation. I just bought it and can start reading it immediately as I have a Kindle.

Anonymous said...

When I know I know more about diabetes than my Internist (after reading Jenny's Diabetes 101 book, followed by Dr. Bernstein's big book) this is a scary state of affairs, especially if I was actually trusting my doctor to know what to do.

I'm already a "bad patient", next thing I'll be a "medical activist". :) I look forward to reading Hippocrates Shadow.