MORE THAN MEDICINE

An argument for redirecting health care funding in the United
States, concentrating less on biomedical research and more on social services,
thereby improving our general health and preventing overspending.

In the U.S., we spend considerably more on developing expensive
medical treatments compared to other economically advanced countries, yet we
often fall behind in terms of life expectancy and quality of life. So argues
Kaplan (Director of Research/Stanford School of Medicine Clinical Excellence
Research Center; The Prophet of Psychiatry: In Search of Reginald
Ellery, 2015, etc.) in this slim but comprehensive new book. The
author rigorously investigates some of the cutting-edge research areas—e.g.,
genetic therapy and precision medicine—funded by the National Institutes of
Health (where the author was a chief science officer) and influenced by the
financial interests of the pharmaceutical industry. He concludes that the
promise of generating astounding cures for particular medical problems is
considerably stronger than the practice. He appeals for increased funding for
improved quality-of-health care that could save thousands of lives, citing the
increased number of deaths each year due to poor treatment and medical errors
(the third-leading cause of death behind heart disease and cancer). Kaplan
further considers issues around race, financial inequality, and lack of
education, pointing to the increased death rates in more impoverished parts of
the country where medicine has done little to improve health outcomes.
Ultimately, the author is not opposed to biomedicine, but he seeks urgent
reforms in how we allocate funding. “It is not my contention that biomedicine
is inherently harmful or useless. Far from it,” he writes. “It is my contention
that researchers and the wider citizenry should continually debate strategies
for extracting public benefit from scientific knowledge. I believe that an open
debate, accountable to the latest evidence, will inspire significant reforms.”

Sharp, authoritative, and intensely data-driven. Though it reads
like an expanded article for a professional medical journal, the argument is
deeply compelling.