Sunday, 10 March 2013

Book review: Rethinking Aging: Growing Old and Living Well in an Overtreated Society


Title: Rethinking Aging: Growing Old and Living Well in an Overtreated Society (2011)
Author: Nortin M Hadler
Publisher: University of North Carolina Press, Chapel Hill

In his latest offering, Dr Hadler rehashes and updates many of his familiar arguments (breast and prostate screening, cardiac stents, osteoporosis, antidepressants, back surgery), this time applying them to the elderly. He adds material specifically about growing frail and dying, and as usual, he provides considerate, accurate, useful and often counter-intuitive information for the would-be health care consumer.

I make no secret of the fact that I like this guy’s message, and that he had a strong influence on the formation of ideas I air in this blog. Many of his familiar targets apply to the older individual, so it would have been relatively easy for him to reshape his message to target that audience. But that doesn’t dilute the message; he remains as sharp as ever and the comprehensive nature of his argument makes it hard to reject.

Apart from decrying specific interventions like those listed above, his general messages often filter down to a few themes, which I will attempt to summarise here.
Many people have aches and pains and develop infirmities. These are part of the human condition and are more common as we age.  Our ability to tolerate and accept those predicaments is largely a reflection of non-physical factors, and helps shape our quality of life. The moment we seek treatment (or have treatment forced upon us) we become patients, our predicament is transformed into symptoms, a disease is fitted and treatment mandated. The ability of medicine to correct conditions that are so dependent on non-physical factors is limited and overstated, but medicine’s ability to harm is not so limited. 

The rest of it is familiar to any of my regular readers. Many interventions are over-rated and may not provide a net benefit. Doctors are biased and fall into the same trap as the patients. The elderly (like all of us) are overtreated, yet treatments are less likely to be effective and more likely to have adverse effects as we age.

The new material is concentrated at the end, when he addresses frailty and dying, and this is the most interesting. Applying his message (above) to the elderly, he states that frailty is a part of life, with positive and negative aspects, and it should be embraced rather than fought or prevented.

Dr Hadler puts the medical treatment of the elderly in perspective by noting that most people over 70 are harbouring some form of cancer and have advanced atherosclerosis. Most die while harbouring many diseases that were vying for the title of killer. Combating one particular disease after the age of 80 is largely futile and probably only serves to decrease the quality of life, and not to prolong it. Through a range of conditions, he shows that the best management of many of the problems afflicting the elderly are non-pharmaceutical and non-surgical.

If I have to criticise Dr Hadler, it would be to say that his language is often aimed above the average reader (his use of big words, latin etc.) and he may therefore be losing many potential readers who could benefit from his advice.

The bottom line
This book offers an interesting, sensible and uplifting view of aging. Most of it, however, is more of the same from Dr Hadler, but that is not a bad thing: his message needs to be repeated until it starts to sink in.

One quote:
Aging is not a disease, and frail elderly persons are not a burden. Aging is a privilege of life in a resource-advantaged society, and the elderly, including frail elderly persons, enrich that society.


4 comments:

  1. So true. So many of us cannot come to terms with the idea of aging and dying. Everyone wants to live longer and healthier yet choose to remain oblivious to the key elements that help get us there. The majority would rather place their health in the hands of medical specialists - the ones that are trained to pass out meds and perform elective surgical procedures. Our ancestors made it possible to be here. We should emulate their exact ways of living including their diet, activity as well as cut out as much of modern day pollutants.

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  2. Patients are bombarded by media, friends, family, misinformed health care providers, infomercials, etc that there is a treatment for every ache, pain, yucky feeling....
    The perfect storm of a patient wanting, demanding, something be done plus financial incentive for the health care system (hospital, surgery center, physician, PT, alt health care provider,etc), and even having someone else responsible for the bill fuels the fire. If you don't provide the "something" to be done the the person goes somewhere else, to someone willing to dish out the treatment. If every health care provider practiced EBM then there could be change. But when you try do do the right thing the patient will just go down the street and get a doctor that is willing to give them what they want or believe. It takes courage to do the right thing. But it hurts...financially and you get isolated from the herd of practitioners trying not to buck the trend.

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    1. I disagree that it is hard to not treat patients. Many say this, and I used to think it, but I regularly manage patients without invasive treatment, and I find that most patients are very accepting of this, and even happy, when adequately explained.
      I agree, however, that many medical systems are stacked against this type of treatment through perverse financial incentives.

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  3. ...to sleep every night is the goodbye "switch off"...and to wake up every morning is the new rebirth "switch on"...and our MEMORY instantly recognized us, if we have lost the Memory...

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