Hope Or Hype

Hope or Hype details why aggressive marketing, profits, politics, the press and a "technoconsumption" culture often trump the best medical science. The authors describe the stakeholders that promote new treatments, examine consumers' embrace of new technology and reveal the whistleblowers, while making a case for a more rational and consistent approach to adopting medical technology.

Dr. Richard Deyo and Dr. Richard Patrick (Seattle, WA) are both professors at the University of Washington. Deyo was co-recipient of the Nellie Westerman Prize for research in medical ethics. He directs a fellowship program for policy-relevant research training, as well as the university’s Center for Cost and Outcomes Research. Patrick is noted for his work on the links between quality of life, cost-effectiveness, and health policy. He has worked on drug studies for a wide variety of illnesses, and is a member of the Institute of Medicine, the most prestigious organization of health experts in the U.S.

Preface: Disillusioned Insiders

ix

Acknowledgments

xv

PART I Can There Be Too Much of a Good Thing? The Hazards of Uncritically Embracing Medical Advances

1 What's the Problem?

Don't We Need Lifesaving New Treatments?

3

(10)

2 Medical Innovations and American Culture

The Call of the Sirens

13

(14)

3 Why More Isn't Always Better

Red Herrings, Side Effects, and Superbugs

27

(14)

4 Why Newer Isn't Always Better

Unpleasant Surprises, Recalls, and Learning Curves

41

(12)

5 Social Hazards

What We Lose by Uncritical Use of New Treatments

53

(12)

PART II How Things Really Work: Opinion Makers and Regulators of Medical Advances

6 What Will You Swallow?

How Drug Companies Get You to Buy More Expensive Drugs Than You May Need

65

(20)

7 Making Friends, Playing Monopoly, and Dirty Tricks

Other Industry Strategies

85

(18)

8 Stacking the Deck?

How to Get the "Right" Answer in Clinical Research

103

(12)

9 "Cancer Cured-Film at 11:00"

The Media's Role in Disseminating Medical Advances

115

(12)

10 doctors and Hospitals

Fueling the Drive for New and More

127

(14)

11 Advocacy Groups

Mother Teresa's Waiting Room

141

(12)

12 Holes in the Safety Net

The FDA and the FTC

153

(16)

PART III Useless, Harmful or Marginal: Popular Treatments That Caused Unnecessary Disability, Dollar Costs, or Death

13 Ineffective, Inferior, or Needlessly Costly New Drugs

169

(16)

14 Medical Devices That Disappoint

185

(14)

15 Ineffective or Needlessly Extensive Surgery

199

(18)

16 Weight Loss Technology

Shedding Pounds from Your Waistline or Your Wallet?

217

(12)

PART IV Crossing the Threshold: Improving the Transition from "Experimental" to "Standard Care"

17 For Doctors

Evidence-Based Medicine

229

(12)

18 For Insurers and Researchers

Pay Now or Pay More Later

241

(12)

19 For All Decision Makers

Getting Value for Money

253

(8)

20 For Government

Regulatory Approaches to Improve the Dissemination of Medical Innovations

261

(12)

21 For Consumers

Shared Decision Making

273

(18)

References

291

(36)

Index

327

(9)

About the Authors

336

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Summary

Author Biography

Table of Contents

Supplemental Materials