Synopses & Reviews
Most of us want and expect medicine’s miracles to extend our lives. In today’s aging society, however, the line between life-giving therapies and too much treatment is hard to see—it’s being obscured by a perfect storm created by the pharmaceutical and biomedical industries, along with insurance companies. In
Ordinary Medicine Sharon R. Kaufman investigates what drives that storm’s “more is better” approach to medicine: a nearly invisible chain of social, economic, and bureaucratic forces that has made once-extraordinary treatments seem ordinary, necessary, and desirable. Since 2002 Kaufman has listened to hundreds of older patients, their physicians and family members express their hopes, fears, and reasoning as they faced the line between enough and too much intervention. Their stories anchor
Ordinary Medicine. Today’s medicine, Kaufman contends, shapes nearly every American’s experience of growing older, and ultimately medicine is undermining its own ability to function as a social good. Kaufman’s careful mapping of the sources of our health care dilemmas should make it far easier to rethink and renew medicine’s goals.
Review
"Sharon R. Kaufman has made an important and disturbing discovery about the links between for-profit healthcare companies, so-called evidence-based medicine, doctors, and patients.
Ordinary Medicine should be read, thought about, and acted upon by those who have the power to effect change."
Review
"I devoured Ordinary Medicine. It gave me courage. It helped me delineate, sometimes for the first time, the interlocking forces and practices that have helped create an epidemic of unnecessary suffering at the end of life. Breathtaking in its scope, rigor, and intellectual range, this book will help readers take back control of their lives and deaths from the forces that have created an 'ordinary' end-of-life medicine that is far from ordinary."
Review
"Ordinary Medicine is an exploration of how what is essentially experimental medicine can become 'standard care.' In this thoroughly researched book, many of our assumptions are shaken. The system that is extant would seem aligned to prevent us from accepting death as a natural life progression and offering in its place prolonged suffering. A truly engaging and provocative read."
Review
"The recommendation by the AMA to Medicare to begin paying physicians for discussions with patients about end-of-life care makes this new book by Sharon Kaufman particularly timely. She explains why the present health care system is biased toward excess treatment at the end of life, and advocates a broad approach to health care reforms that goes beyond cost control to encompass social and ethical considerations."
Review
“Medical anthropologist Kaufman bravely delves into the heartbreaking predicament of modern medicine: ‘getting the medicine we wish for but then having to live with the unsettling and far-ranging consequences.’ … Kaufman is at her best when focusing on the heartbreaking dilemma of patients dealing with the consequences of ordinary medicine, such as an elderly patient who must choose between lifesaving treatments or palliative care, facing repeated hospital visits regardless of the choice. Kaufman calls for no less than making the ethics of medicine the ‘preeminent topic of our national conversation about health care reform.’”
Review
“What makes Kaufman's analysis distinctive is the way she demonstrates the effects of Medicare policy on treatment benefits—namely, if a patient on Medicare is eligible for treatment, providers are often willing to supply it. But the author notes that this way of thinking has led us to stop examining issues around quality of life, obligations to our families, and the inevitable prospect that we will die. Health-care professionals, students of medical ethics, and others interested in the actions that frame American medicine will find this a thought-provoking read."
Synopsis
Sharon R. Kaufman examines the quandary of patients, families and doctors not knowing the point where enough medical treatment becomes too much treatment. A hidden chain of drivers among science, industry, new technology, and insurance spur this quandary, serving to obscure the ability to identify the difference between extraordinary and ordinary medicine.
About the Author
Sharon R. Kaufman is Chair of the Department of Anthropology, History and Social Medicine at the University of California, San Francisco. She is the author of
…And a Time to Die: How American Hospitals Shape the End of Life.
Table of Contents
Acknowledgments ix
Introduction. Diagnosing Twenty-First-Century Health Care 1
Part I: The Quandry and Unexamined Ordinariness of Twenty-First-Century Medicine
1. Ordinary Medicine in Our Aging Society: The Dilemma of Longevity 21
Part II. The Chain of Health Care Drivers
2. The Medical-Industrial Complex I: Evidence-Based Medicine, the Biomedical Economy, and the Ascendance of Clinical Trials 53
3. The Medical-Industrial Complex II: Access, Industry, and the Clincial Trials Phenomenon 79
4. "Reimbursement Is Critical for Everything": Medicare and the Ethics of Managing Life 99
Part III: Medicine's Changing Means and Ends
5. Standard and Necessary Treatments: The Changing Means and Ends of Technology 127
6. Family Matters: Kidneys and New Forms of Care 165
7. Influencing the Character of the Future: Prognosis, Risk, and Time Left 195
8. For Whose Benefit? Our Shared Quandary 217
Conclusion. Toward a New Social Contract? 238
Notes on the Research 249
Notes 255
Bibliography 285
Index 307