Needed: a nation of health care skeptics

by Vicky Dickson

Dr. Nortin Hadler is on a mission to change the way health care is delivered in this country. He doesn’t mince words in his estimation of the problems the system faces: “No American can rest easy or secure until we address replac[ing] the American ‘health care system’ with one that displaces profit with reason on the moral high ground.”

Dr. Nortin Hadler. Photo by Paul Braly

Hadler excoriates medical institutions, insurance companies, drug and device makers and other players for frequently putting their own interests before the well being of patients.

But no reader should assume from that that Hadler rejects Western medical practice itself. No one should think that, in criticizing the system in which physicians are increasingly forced to practice, Hadler is denigrating physicians themselves. To the contrary – Dr. Hadler, a practicing rheumatologist who’s taught at the UNC School of Medicine for nearly 40 years, believes that “the greatest resource in the American health care system is the generations of bright, ethical and committed young women and men who have entered medicine following my generation.”

But: “Few can practice according to their conscience. If they did, they’d starve. Informed medical decision-making requires physician-patient trust and time. In America, it takes 20 seconds to write a prescription or order a test; it takes 20 minutes or more not to do either – and neither activity goes far to decreasing the office ‘overhead.’”

The necessity of contributing to medical overhead – the administrative costs, the upkeep of hugely expensive facilities and equipment, the costs of insurance processing – combined with drug and medical-supply companies’ demand for ever-increasing profits has led, Hadler believes, to the increasing “medicalization” of conditions that are more appropriately viewed as stages of life. It has led to the widespread overuse of screening tests that have little likelihood of detecting disease in any given, asymptomatic, patient. And it has led to surgical procedures being performed that have more potential to harm than help the patients who undergo them.

Hadler has been publicly challenging the medical status quo for a decade, and in the process has produced four books for the general reader: The Last Well Person, Worried Sick, Stabbed in the Back and his latest release, Rethinking Aging: Growing Old and Living Well in an Overtreated Society.

Hadler’s theme in Rethinking Aging is that aging is a natural process that we should embrace, rather than attempt to resist with dubious medical interventions. His studies of U.S. Public Health Service demographic data having convinced him that 85 is probably the maximum age to which most of us should aspire, he sees this as “a fact of life that allows us to restructure fear of death into joie de vivre as we age well past 60.” Since ill-advised medical intervention can seriously interfere with one’s enjoyment of life, or even lead to premature death, it’s crucial for elderly patients and their advocates to have a clear understanding of the risks as well as the possible benefits of every medical procedure they are advised to undertake.

Hadler believes that the doctor-patient relationship that best serves both is one that “holds the patient up as the captain of the ship and the doctor as but a navigator.” To encourage such relationships, he’s filled Rethinking Aging with a wealth of information on various commonly recommended tests and procedures, ranging from mammograms and PSAs to cardiac stents and back surgery. And even more importantly, he’s provided his readers with valuable perspective that should make it easier for them to captain the ships of their own health.

Given the current trajectory of health care costs, reducing unnecessary medical procedures should be a national as well as an individual priority. Hadler says what’s needed is “a nation of skeptics willing to ask pointed questions of anyone who offers them ‘health care’ and willing to walk when the answers seem evasive.”
To our great benefit, he’s leading the charge.

Contact Vicky Dickson at