Lifelong Learning
Strong Medicine
Professor challenges practices that ‘don’t save lives and don’t improve symptoms’
UNC School of Medicine Professor Nortin M. Hadler stood at the podium
in the National Press Club in Washington,
D.C., and told the roughly 100 people in
attendance that he would spend the next
45 minutes trashing the institution of medicine in the U.S.
“And,” he said, “I’m not going to be
gentle.”
The trashing, he noted, would have one
important caveat: “I don’t bash doctors.
Medicine is a ministry for me. I’ve been
working in hospitals since I was 11 years
old. There is nothing more important and
more privileged than the care of a patient
and a fellow human being who turn to one
another in trust. I’ve been a medical educator for 35 years. There is nothing about that
I consider trivial.”
But there is, he said, a lot that is terribly
wrong with how medicine is practiced in
the U.S. Too many people subject themselves to too many medical interventions
— surgical procedures, diagnostic tests and
prescription drugs — that are outrageously
expensive and marginally effective, if at all.
“You never, ever, ever, ever want to be
screened,” he said, “unless the test is accurate, the disease is important and you can
do something about it.”
Cholesterol, he said, is a prime case. “I
have no idea what my cholesterol is. I
know that’s un-American, but I could [not]
care less.”
A study conducted with 6,595 Scottish
men in the mid-1990s found that a choles-terol-fighting drug failed to protect anyone
from a fatal heart attack. “Not a single life
was saved,” Hadler said.
Hadler’s talk was presented as part of the
GAA’s Lifelong Learning programs and
hosted by the Washington, D.C., Carolina
Club. He has given several talks at GAA
events about one of his books — Worried
Sick: A Prescription for Health in an
Overtreated America, published by UNC
Press in 2008 — in which he cites numerous studies that challenge the worthiness of
medical procedures that have been largely
believed to make a significant difference in
curing disease and saving lives.
He takes on the much-touted benefits of
DAN SEARS ’ 74
everything from breast cancer screenings to
back surgery to the repair of clogged coronary arteries. And, true to fashion, he is not
gentle.
“Interventional cardiology and cardiovascular surgery,” he says in his book, “are the
cash cows, if not the engines driving all
that’s indefensible about the American
health-care delivery system.”
UNC School of Medicine Professor Nortin M. Hadler says that when hospitals’ business models began looking at patients as
“units of care,” he had to speak up, using articles, interviews, speeches and books to challenge the effectiveness of many
expensive tests and procedures. “I want us as a country to say, ‘Wait a minute. Is this money well spent and does it advantage
me?’ ”
“He drew a good crowd,
but it should have been
standing room only at the
Washington convention center.”
U.S. Rep. Jim Cooper ’ 75, Tennessee
Studies have shown, he said, that medical
therapies such as the judicious prescription
of medicines, along with changes in diet
and exercise habits, are at least as effective as
bypass surgery or angioplasty. “We can put
sick people to sleep and do violent things
to their heart, and most of them wake up,”
he said. But after they wake up, roughly half
are depressed for six months, about 30 per-
cent still suffer some degree of memory loss
after the first year, and only 3 percent are
likely to live longer as a result.
The people who came to hear Hadler’s
message in Washington comprised an eclectic group. Several were former UNC medical students; some were advocates of holistic medicine; one was a lawyer who sometime uses Hadler as an expert witness; one
was a 67-year-old UNC alumnus who
hoped to find relief from the 14 pills he
takes every day; and another was Jim
Cooper ’ 75, a congressman from Tennessee.
“He drew a good crowd,” Cooper said,
“but it should have been standing room
only at the Washington convention center.”
The congressman, who agrees wholeheartedly with Hadler’s assessment of the
American health care system, said the issue
is problematic for Congress. “We have had
great difficulty dealing with this,” he said.
“Every vendor in America attacks Congress
if we even try to find out what’s effective
and what’s not.”
Hadler, Cooper noted, is “not just a theoretician. He’s been a hands-on medical
doctor for decades. He actually knows what
he’s talking about. He’s superbly well-educated, and he’s enough of a maverick to
