In Pain: A Bioethicist's Personal Struggle with Opioids


Travis Rieder - 2019
    Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself.Rieder’s experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system.In Pain in America is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age


Robert M. Wachter - 2015
    For the past few decades, technology has been touted as the cure for all of healthcare's ills.But medicine stubbornly resisted computerization - until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital.Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America's leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point?Logically enough, we've pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . .Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation's most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story."We need to recognize that computers in healthcare don't simply replace my doctor's scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it's not too late to get it right."This riveting book offers the prescription for getting it right, making it essential reading for everyone - patient and provider alike - who cares about our healthcare system.

The Upstream Doctors (TED)


Rishi Manchanda - 2013
    But that picture is vastly incomplete. In this eye-opening book, physician Rishi Manchanda says that our health may depend even more on our social and environmental settings than it does on our most cutting-edge medical care. Manchanda argues that that the future of our health care depends on growing a new generation of health care practitioners. We need doctors who look upstream for the sources of our problems, rather than simply go for quick-hit symptomatic relief. These upstreamists, as he calls them, are doctors and nurses on the frontlines of medicine who see that health (like sickness) is more than a chemical equation that can be balanced with pills and procedures administered within clinic walls. They see that health begins in our everyday lives, in the places where we live, work, eat, and play. If our high-cost, sick-care system is to become a high-value, health care system, the upstreamists will show us the way. (Description taken from TED Library: http://www.ted.com/pages/tedbooks_lib...)

Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients


Ben Goldacre - 2012
    We like to imagine that it’s based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry. We like to imagine that regulators let only effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.All these problems have been protected from public scrutiny because they’re too complex to capture in a sound bite. But Dr. Ben Goldacre shows that the true scale of this murderous disaster fully reveals itself only when the details are untangled. He believes we should all be able to understand precisely how data manipulation works and how research misconduct on a global scale affects us. In his own words, “the tricks and distortions documented in these pages are beautiful, intricate, and fascinating in their details.” With Goldacre’s characteristic flair and a forensic attention to detail, Bad Pharma reveals a shockingly broken system and calls for something to be done. This is the pharmaceutical industry as it has never been seen before.

Critical: What We Can Do About the Health-Care Crisis


Tom Daschle - 2008
     Undoubtedly, the biggest domestic policy issue in the coming years will be America’s health-care system. Millions of Americans go without medical care because they can’t afford it, and many others are mired in debt because they can’t pay their medical bills. It’s hard to think of another public policy problem that has lingered unaddressed for so long. Why have we failed to solve a problem that is such a high priority for so many citizens? Former Senate Majority Leader Tom Daschle believes the problem is rooted in the complexity of the health-care issue and the power of the interest groups—doctors, hospitals, insurers, drug companies, researchers, patient advocates—that have a direct stake in it. Rather than simply pointing out the major flaws and placing blame, Daschle offers key solutions and creates a blueprint for solving the crisis. Daschle’s solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board would offer a public framework within which a private health-care system can operate more effectively and efficiently—insulated from political pressure yet accountable to elected officials and the American people. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector. After decades of failed incremental measures, the American health-care system remains fundamentally broken and requires a comprehensive fix. With his bold and forward-looking plan, Daschle points us to the solution.

Prescription for the Future: The Twelve Transformational Practices of Highly Effective Medical Organizations


Ezekiel J. Emanuel - 2017
    Ezekiel J. Emanuel looks at individual physician practices and organizations who are already successfully driving change, and the specific practices they have instituted. They are not the titans everyone seems to know and assume to be the "best"; instead, Emanuel has chosen a select group -- from small physician offices to large multi-specialty group practices, accountable care organizations, and even for-profit companies--that are genuinely transforming care.Prescription for the Future shines a bright diagnostic light on the state of American healthcare and provides invaluable insights for healthcare workers, investors, and patients. The book gives all of us the tools to recognize the places that will deliver high-quality, effective care when we need it.

The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS


Elizabeth Pisani - 2008
    With swashbuckling wit and fierce honesty, she dishes on herself and her colleagues as they try to prod reluctant governments to fund HIV prevention for the people who need it most—drug injectors, gay men, sex workers, and johns.Pisani chats with flamboyant Indonesian transsexuals about their boob jobs and watches Chinese streetwalkers turn away clients because their SUVs aren't nice enough. With verve and clarity, she shows the general reader how her profession really works; how easy it is to draw wrong conclusions from "objective" data; and, shockingly, how much money is spent so very badly. "Exhibit A": the 45 billion taxpayer dollars the Bush administration is committing to international AIDS programs.

Betrayal of Trust: The Collapse of Global Public Health


Laurie Garrett - 2000
    Garrett also exposes the ungoverned world of biological terrorism.

Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital


David M. Oshinsky - 2016
    From its origins in 1738 as an almshouse and pesthouse, Bellevue today is a revered public hospital bringing first-class care to anyone in need. With its diverse, ailing, and unprotesting patient population, the hospital was a natural laboratory for the nation's first clinical research. It treated tens of thousands of Civil War soldiers, launched the first civilian ambulance corps and the first nursing school for women, pioneered medical photography and psychiatric treatment, and spurred New York City to establish the country's first official Board of Health. As medical technology advanced, "voluntary" hospitals began to seek out patients willing to pay for their care. For charity cases, it was left to Bellevue to fill the void. The latter decades of the twentieth century brought rampant crime, drug addiction, and homelessness to the nation's struggling cities problems that called a public hospital's very survival into question. It took the AIDS crisis to cement Bellevue's enduring place as New York's ultimate safety net, the iconic hospital of last resort.

A World without Cancer: The Making of a New Cure and the Real Promise of Prevention


Margaret I. Cuomo - 2012
    Margaret I. Cuomo is inspired to seek out new strategies for waging a smarter war on cancer.This year, about 1.6 million new cases of cancer will be diagnosed and more than 1,500 people will die "per day." We've been asked to accept the disappointing strategy to "manage cancer as a chronic disease." We've allowed pharmaceutical companies to position cancer drugs that extend life by just weeks and may cost $100,000 for a single course of treatment as breakthroughs. Where is the bold leadership that will transform our system from treatment to prevention? Have we forgotten the mission of the National Cancer Act of 1971 to "conquer cancer"?Through an analysis of more than 40 years of medical evidence and interviews with the top cancer researchers, drug company executives, and health policy advisers, Dr. Cuomo reveals intriguing answers to these questions. She shows us how all cancer stakeholders--the pharmaceutical industry, the government, physicians, and concerned Americans--can change the way we view and fight cancer in this country.

The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor


Andy Kessler - 2006
    Too bad. Because medicine isn't an industry, it's practically witchcraft. Despite the growth of big pharma, HMOs, and hospital chains, medicine remains the isolated work of individual doctors—and the system is going broke fast.So why is Andy Kessler—the man who told you outrageous stories of Wall Street analysts gone bad in Wall Street Meat and tales from inside a hedge fund in Running Money—poking around medicine for the next big wave of technology?It's because he smells change coming. Heart attacks, strokes, and cancer are a huge chunk of medical spending, yet there's surprisingly little effort to detect disease before it's life threatening. How lame is that—especially since the technology exists today to create computer-generated maps of your heart and colon?Because it's too expensive—for now. But Silicon Valley has turned computing, telecom, finance, music, and media upside down by taking expensive new technologies and making them ridiculously cheap. So why not the $1.8 trillion health care business, where the easiest way to save money is to stop folks from getting sick in the first place?Join Kessler's bizarre search for the next big breakthrough as he tries to keep from passing out while following cardiologists around, cracks jokes while reading mammograms, and watches twitching mice get injected with radioactive probes. Looking for a breakthrough, Kessler even selflessly pokes, scans, and prods himself.CT scans of your heart will identify problems before you have a heart attack or stroke; a nanochip will search your blood for cancer cells--five years before they grow uncontrollably and kill you; and baby boomers can breathe a little easier because it's all starting to happen now.Your doctor can't be certain what's going on inside your body, but technology will. Embedding the knowledge of doctors in silicon will bring a breakout technology to health care, and we will soon see an end of medicine as we know it.

Ten Lessons for a Post-Pandemic World


Fareed Zakaria - 2020
    CNN host and best-selling author Fareed Zakaria helps readers to understand the nature of a post-pandemic world: the political, social, technological, and economic impacts that may take years to unfold.In the form of ten straightforward “lessons,” covering topics from globalization and threat-preparedness to inequality and technological advancement, Zakaria creates a structure for readers to begin thinking beyond the immediate impacts of COVID-19. Ten Lessons for a Post-Pandemic World speaks to past, present, and future, and, while urgent and timely, is sure to become an enduring staple.

Your Money or Your Life: Strong Medicine for America's Health Care System


David M. Cutler - 2003
    Medical care is in crisis, we are repeatedly told, and so it is. Barely one in five Americans thinks the medical system works well. Enter David M. Cutler, a Harvard economist who served on President Clinton's health care task force and later advised presidential candidate Bill Bradley. One of the nation's leading experts on the subject, Cutler argues in Your Money or Your Life that health care has in fact improvedexponentially over the last fifty years, and that the successes of our system suggest ways in which we might improve care, make the system easier to deal with, and extend coverage to all Americans. Cutler applies an economic analysis to show that our spending on medicine is well worth it--and thatwe could do even better by spending more. Further, millions of people with easily manageable diseases, from hypertension to depression to diabetes, receive either too much or too little care because of inefficiencies in the way we reimburse care, resulting in poor health and in some cases prematuredeath. The key to improving the system, Cutler argues, is to change the way we organize health care. Everyone must be insured for the medical system to perform well, and payments should be based on the quality of services provided not just on the amount of cutting and poking performed. Lively and compelling, Your Money or Your Life offers a realistic yet rigorous economic approach to reforming health care--one that promises to break through the stalemate of failed reform.

The DOs: Osteopathic Medicine in America


Norman Gevitz - 1982
    The DOs chronicles the development of this controversial medical movement from the nineteenth century to the present. Historian Norman Gevitz describes the philosophy and practice of osteopathy, as well as its impact on medical care. From the theories underlying the use of spinal manipulation developed by osteopathy's founder, Andrew Taylor Still, Gevitz traces the movement's early success, despite attacks from the orthodox medical community, and details the internal struggles to broaden osteopathy's scope to include the full range of pharmaceuticals and surgery. He also recounts the efforts of osteopathic colleges to achieve parity with institutions granting M.D. degrees and looks at the continuing effort by osteopathic physicians and surgeons to achieve greater recognition and visibility.In print continuously since 1982, The DOs has now been thoroughly updated and expanded to include two new chapters addressing recent and current challenges and to bring the history of the profession up to the beginning of the new millennium.

Priced Out: The Economic and Ethical Costs of American Health Care


Uwe Reinhardt - 2019
    Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging and enlightening account of today's U.S. health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it.The problem, Reinhardt says, is not one of economics but of social ethics. There is no American political consensus on a fundamental question other countries settled long ago: to what extent should we be our brothers' and sisters' keepers when it comes to health care? Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America finances health care, and he offers a penetrating ethical analysis of recent reform proposals. At this point, he argues, the United States appears to have three stark choices: the government can make the rich help pay for the health care of the poor, ration care by income, or control costs. Reinhardt proposes an alternative path: that by age 26 all Americans must choose either to join an insurance arrangement with community-rated premiums, or take a chance on being uninsured or relying on a health insurance market that charges premiums based on health status.An incisive look at the American health care system, Priced Out dispels the confusion, ignorance, myths, and misinformation that hinder effective reform.