This new edition includes an all-embracing and incisive afterword that examines the current state of health care and our relationship with life as it approaches its terminus. It also discusses how we can take control of our own final days and those of our loved ones.Shewin Nuland's masterful How We Die is even more relevant than when it was first published.

    But nowhere is this drive to do better more important than in medicine, where lives are on the line with every decision. In his new book, Atul Gawande explores how doctors strive to close the gap between best intentions and best performance in the face of obstacles that sometimes seem insurmountable. Gawande's gripping stories of diligence, ingenuity, and what it means to do right by people take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. He discusses the ethical dilemmas of doctors participation in lethal injections, examines the influence of money on modern medicine, and recounts the astoundingly contentious history of hand washing. And as in all his writing, Gawande gives us an inside look at his own life as a practicing surgeon, offering a searingly honest firsthand account of work in a field where mistakes are both unavoidable and unthinkable. At once unflinching and compassionate, Better is an exhilarating journey narrated by arguably the best nonfiction doctor-writer around (Salon). Gawande's investigation into medical professionals and how they progress from merely good to great provides rare insight into the elements of success, illuminating every area of human endeavor.

    R. Reid shows how all the other industrialized democracies have achieved something the United States can’t seem to do: provide health care for everybody at a reasonable cost. In his global quest to find a possible prescription, Reid visits wealthy, free market, industrialized democracies like our own—including France, Germany, Japan, the U.K., and Canada—where he finds inspiration in example. Reid sees problems too: He finds poorly paid doctors in Japan, endless lines in Canada, mistreated patients in Britain, spartan facilities in France. In addition to long-established systems, Reid also studies countries that have carried out major health care reform. The first question facing these countries—and the United States, for that matter—is an ethical issue: Is health care a human right?The Healing of America lays bare the moral question at the heart of our troubled system, dissecting the misleading rhetoric surrounding the health care debate: Is health care a human right?

    What is going on? Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled—and dismayed—to discover what was reported in the scientific journals. Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?  This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated or unmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit?  By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?  In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.

    In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong -- with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track.Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems.How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

    By combining analysis of the historical evidence with the latest psychiatric research, Ghaemi demonstrates how he thinks these qualities have produced brilliant leadership under the toughest circumstances.individuals and society at large-however high the price for those who endure these illnesses.

    On the eve of this centenary, journalist Johann Hari set off on an epic three-year, thirty-thousand-mile journey into the war on drugs. What he found is that more and more people all over the world have begun to recognize three startling truths: Drugs are not what we think they are. Addiction is not what we think it is. And the drug war has very different motives to the ones we have seen on our TV screens for so long.In Chasing the Scream, Hari reveals his discoveries entirely through the stories of people across the world whose lives have been transformed by this war. They range from a transsexual crack dealer in Brooklyn searching for her mother, to a teenage hit-man in Mexico searching for a way out. It begins with Hari's discovery that at the birth of the drug war, Billie Holiday was stalked and killed by the man who launched this crusade--and it ends with the story of a brave doctor who has led his country to decriminalize every drug, from cannabis to crack, with remarkable results.Chasing the Scream lays bare what we really have been chasing in our century of drug war--in our hunger for drugs, and in our attempt to destroy them. This book will challenge and change how you think about one of the most controversial--and consequential--questions of our time.

    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.

    is the first deep-dive investigation of a hazardous and illicit industry that has created a worldwide epidemic, ravaging communities and overwhelming and confounding government agencies that are challenged to combat it. "A whole new crop of chemicals is radically changing the recreational drug landscape," writes Ben Westhoff. "These are known as Novel Psychoactive Substances (NPS) and they include replacements for known drugs like heroin, cocaine, ecstasy, and marijuana. They are synthetic, made in a laboratory, and are much more potent than traditional drugs"--and all-too-often tragically lethal. Drugs like fentanyl, K2, and Spice--and those with arcane acronyms like 25i-NBOMe-- were all originally conceived in legitimate laboratories for proper scientific and medicinal purposes. Their formulas were then hijacked and manufactured by rogue chemists, largely in China, who change their molecular structures to stay ahead of the law, making the drugs' effects impossible to predict. Westhoff has infiltrated this shadowy world, becoming the first journalist to report from inside an illicit Chinese fentanyls lab and providing startling and original reporting on how China's vast chemical industry operates, and how the Chinese government subsidizes it. He tracks down the little-known scientists who invented these drugs and inadvertently killed thousands, as well as a mysterious drug baron who turned the law upside down in his home country of New Zealand. Poignantly, Westhoff chronicles the lives of addicted users and dealers, families of victims, law enforcement officers, and underground drug awareness organizers in the U.S. and Europe. Together they represent the shocking and riveting full anatomy of a calamity we are just beginning to understand. From its depths, as Westhoff relates, are emerging new strategies that may provide essential long-term solutions to the drug crisis that has affected so many.

    But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system is twice as good.Instead, startling new evidence suggests that one out of every three of our health care dollars is squandered on unnecessary or redundant tests; unproven, sometimes unwanted procedures; and overpriced drugs and devices that, too often, are no better than the less expensive products they have replaced.How did this happen? In Money-Driven Medicine, Maggie Mahar takes the reader behind the scenes of a $2 trillion industry to witness how billions of dollars are wasted in a Hobbesian marketplace that pits the industry's players against each other. In remarkably candid interviews, doctors, hospital administrators, patients, health care economists, corporate executives, and Wall Street analysts describe a war of "all against all" that can turn physicians, hospitals, insurers, drugmakers, and device makers into blood rivals. Rather than collaborating, doctors and hospitals compete. Rather than sharing knowledge, drugmakers and device makers divide value. Rather than thinking about long-term collective goals, the imperatives of an impatient marketplace force health care providers to focus on short-term fiscal imperatives. And so investments in untested bleeding-edge medical technologies crowd out investments in information technology that might, in the long run, not only reduce errors but contain costs.In theory, free market competition should tame health care inflation. In fact, Mahar demonstrates, when it comes to medicine, the traditional laws of supply and demand do not apply. Normally, when supply expands, prices fall. But in the health care industry, as the number and variety of drugs, devices, and treatments multiplies, demand rises to absorb the excess, and prices climb. Meanwhile, the perverse incentives of a fee-for-service system reward health care providers for doing more, not less.In this superbly written book, Mahar shows why doctors must take responsibility for the future of our health care industry. Today, she observes, "physicians have been stripped of their standing as professionals: Insurers address them as vendors ('Dear Health Care Provider'), drugmakers and device makers see them as customers (someone you might take to lunch or a strip club), while . . . consumers (aka patients) are encouraged to see their doctors as overpaid retailers. . . . Before patients can reclaim their rightful place as the center—and indeed as the raison d'être—of our health care system," Mahar suggests, "we must once again empower doctors . . . to practice patient-centered medicine—based not on corporate imperatives, doctors' druthers, or even patients' demands," but on the best scientific research available.

    By 1988 she was living at home but was brain dead after a tragic cycle of misunderstanding, over-medication, and culture clash: "What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance." The Spirit Catches You and You Fall Down is a tragedy of Shakespearean dimensions, written with the deepest of human feeling. Sherwin Nuland said of the account, "There are no villains in Fadiman's tale, just as there are no heroes. People are presented as she saw them, in their humility and their frailty—and their nobility.

    Forced to remain inside until they'd "proven" themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan's study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever. But, as Cahalan's new research shows, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?

    From a fortress-like former bank building, American Pain's doctors distributed massive quantities of oxycodone to hundreds of customers a day, mostly traffickers and addicts who came by the vanload. Inked muscle-heads ran the clinic's security. Former strippers operated the pharmacy, counting out pills and stashing cash in garbage bags. Under their lab coats, the doctors carried guns and it was all legal sort of. American Pain was the brainchild of Chris George, a 27-year-old convicted drug felon. The son of a South Florida home builder, Chris George grew up in ultra-rich Wellington, where Bill Gates, Springsteen, and Madonna kept houses. Thick-necked from weightlifting, he and his twin brother hung out with mobsters, invested in strip clubs, brawled with cops, and grinned for their mug shots. After the housing market stalled, a local doctor clued in the brothers to the burgeoning underground market for lightly regulated prescription painkillers. In Florida, pain clinics could dispense the meds, and no one tracked the patients. Seizing the opportunity, Chris George teamed up with the doctor, and word got out. Just two years later Chris had raked in $40 million, and 90 percent of the pills his doctors prescribed flowed north to feed the rest of the country's insatiable narcotics addiction. Meanwhile, hundreds more pain clinics in the mold of American Pain had popped up in the Sunshine State, creating a gigantic new drug industry. American Pain chronicles the rise and fall of this game-changing pill mill, and how it helped tip the nation into its current opioid crisis, the deadliest drug epidemic in American history. The narrative swings back and forth between Florida and Kentucky, and is populated by a gaudy and diverse cast of characters. This includes the incongruous band of wealthy bad boys, thugs and esteemed physicians who built American Pain, as well as penniless Kentucky clans who transformed themselves into painkiller trafficking rings. It includes addicts whose lives were devastated by American Pain's drugs, and the federal agents and grieving mothers who labored for years to bring the clinic's crew to justice."

    

    Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D.The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, ‘What is wrong with me?’ They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it–on some level–restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer.A healthy young man suddenly loses his memory–making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment–only to have their symptoms mysteriously return. A young woman lies dying in the ICU–bleeding, jaundiced, incoherent–and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis.Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness–the diagnosis–revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient’s story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients’ lives.