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More than Medicine: The Broken Promise of American Health Hardcover – Illustrated, Feb. 4 2019

by Robert M. Kaplan (Author)
4.9 4.9 out of 5 stars 16 ratings
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Stanford’s pioneering behavioral scientist draws on a lifetime of research and experience guiding the NIH to make the case that America needs to radically rethink its approach to health care if it wants to stop overspending and overprescribing and improve people’s lives.

American science produces the best―and most expensive―medical treatments in the world. Yet U.S. citizens lag behind their global peers in life expectancy and quality of life. Robert Kaplan brings together extensive data to make the case that health care priorities in the United States are sorely misplaced. America’s medical system is invested in attacking disease, but not in addressing the social, behavioral, and environmental problems that engender disease in the first place. Medicine is important, but many Americans act as though it were all important.

The United States stakes much of its health funding on the promise of high-tech diagnostics and miracle treatments, while ignoring strong evidence that many of the most significant pathways to health are nonmedical. Americans spend millions on drugs for high cholesterol, which increase life expectancy by only six to eight months on average. But they underfund education, which might extend life expectancy by as much as twelve years. Wars on infectious disease have paid off, but clinical trials for chronic conditions―costing billions―rarely confirm that new treatments extend life. Meanwhile, the National Institutes of Health spends just 3 percent of its budget on research on the social and behavioral determinants of health, even though these factors account for 50 percent of premature deaths.

America’s failure to take prevention seriously costs lives. More than Medicine argues that we need a shakeup in how we invest resources, and it offers a bold new vision for longer, healthier living.

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  1. Print length
    240 pages
  2. Language
    English
  3. Publisher
    Harvard University Press
  4. Publication date
    Feb. 4 2019
  5. Dimensions
    13.97 x 2.29 x 20.96 cm
  6. ISBN-10
    0674975901
  7. ISBN-13
    978-0674975903
  8. See all details
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Product description

Review

“Kaplan…argues that our enthusiasm for biomedical science has inflated health-care costs while encouraging us to neglect more fundamental determinants of ill health, such as behavior and social conditions.”―Chris Pope, Wall Street Journal

“Many Americans are already aware of the extraordinary cost of health care in the United States. This fact is frequently explained away by asserting that such is the price to be paid for the best health care system in the world. Kaplan’s book shatters that comforting myth and exposes the American health care system for what it is: below average in quality and therefore way above average in cost.”―Joseph Q. Jarvis, American Interest

“More than Medicine makes a clear and compelling case for why America’s overspending on medical care contributes to poor health outcomes. To improve health and well-being in current and future generations, we must heed Kaplan’s call to prioritize financial support for the social determinants of health.”―Jonathan Fielding, UCLA Fielding School of Public Health

“This is the right book, by the right author, at the right time. Kaplan asks a simple question that should concern all of us: why do we spend so much on health but have such poor results? He challenges the fundamental premise that has guided much of American biomedicine for the past half century: that we will achieve health through medical intervention. He makes a convincing argument that we need to think differently―that the promotion of health and prevention of disease should motivate our spending.”―Sandro Galea, Boston University School of Public Health

“From one of the world’s leading experts on public health, a brilliant data-driven examination of the mismatch between the pathways to optimal health and the narrow focus of legacy medicine. More than Medicine offers a new vision to advance health, science, and public policy.”―Howard S. Friedman, author of The Longevity Project

“By combining scientific and clinical evidence with rare insight into political funding processes, Kaplan argues persuasively that the vast amount of money we spend on health care is not worth the cost. More than Medicine challenges us to reincorporate the essential element of human care back into medicine.”―Rose McDermott, Brown University

“Sharp, authoritative, and intensely data-driven…The argument is deeply compelling.”―Kirkus Reviews

“Kaplan’s call to ‘rethink’ how health-care costs could be lowered through greater attention to disease prevention and social and behavioral risk factors is worth noting.”―Publishers Weekly

About the Author

Robert M. Kaplan is Director of Research at the Stanford School of Medicine Clinical Excellence Research Center. He has served as Associate Director of the National Institutes of Health. He is past president of the American Psychological Association Division of Health Psychology, the International Society for Quality of Life Research, and the Society of Behavioral Medicine, and is former Editor in Chief of Health Psychology and the Annals of Behavioral Medicine.

Product details

  • Publisher ‏ : ‎ Harvard University Press; Illustrated edition (Feb. 4 2019)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 240 pages
  • ISBN-10 ‏ : ‎ 0674975901
  • ISBN-13 ‏ : ‎ 978-0674975903
  • Item weight ‏ : ‎ 386 g
  • Dimensions ‏ : ‎ 13.97 x 2.29 x 20.96 cm
  • Customer Reviews:
    4.9 4.9 out of 5 stars 16 ratings

Customer reviews

4.9 out of 5 stars
4.9 out of 5
16 global ratings

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Saty Satya-Murti
5.0 out of 5 stars I hold similar views, and I still like this book that urges rethinking the value of biomedicine.
Reviewed in the United States on May 8, 2019
Verified Purchase
We have to question the value of conventional individual-oriented diagnostic and therapeutic advances. They are often brilliant but do not always address wellness and health of people and populations at large. We have immediate causes of illnesses: infections, trauma, overdose, reckless behavior etc. But then what is the cause behind these immediate causes? Is it childhood abuse, poverty, lack of education, unemployment, absent public transportation, poor unsafe environment and prejudice? These malfunctioning social roots incend and build up towards the more immediate proximal causes of illnesses.

Kaplan describes in limpid detail the failure of our current biomedical emphasis to recognize and remedy the social determinants of health.
We have grown accustomed to mistaking healthcare, as provided by our doctor and hospital centered encounters, with health, wellness and flourishing overall. Kaplan, a veteran researcher and astute observer, takes us through an easy hike. On the way he points out how we allocate unequal resources to technologically based expensive therapies and diagnostic efforts and tend to underfeed research into social causes underlying diseases. There are examples, aplenty, of overdiagnosis and harms of unnecessary treatments. A few good graphics are also included. One sentence, and there are many such, impressed me especially: "Indeed undiagnosed diseases are common and not necessarily harmful."

There have been other authors such as Gilbert Welch, late Lisa Schwartz, Steven Woloshin, Nortin Hadler, Barbara Ehrenreich, Michael Marmot and many others including Ivan Illich decades ago, who have written and expressed similar views. Kaplan's work parallels the work of these authors, and is the latest of this ilk. He has been more of an insider, and his tenure in the past has included leaderships in national grant giving institutions also.

This book is richly referenced, well-indexed and the 7 chapters are balanced. My own confirmation bias leads me to this favorable review. Dissenting evaluations about "the broken promise of american health" are also legitimate. Any average day's news feed will infuse one with plenty of such examples.
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R. hamilton
5.0 out of 5 stars Just getting to average would be a win.......
Reviewed in the United States on May 28, 2019
Verified Purchase
I just finished Robert Kaplan’s book titled, “More Than Medicine.”

Dr. Kaplan is a former Associate Director at the National Institute of Health and Director of Research at Stanford School of Medicine where he focused on improving quality, efficacy, and the safety of healthcare,

It is a fascinating look at a topic of interest to most any sentient human, our health and well-being. Dr. Kaplan takes us on a tour of world and national health care with an emphasis on the changes in the US since WWII.

The set up is that the United States, the richest country in the history of the world, does not have the best health care outcomes or life expectancy yet spends 50% more than other developed nations, even those with universal health care coverage. The US spends 18% of our GDP on health care, while the rest of the developed world averages around 11%. If we could just get to “average” outcomes and costs of our peers, we would save $1 Trillion per year, expand life expectancy by several years, reduce infant mortality, and most importantly improve our quality of life.

The author does not just lament the problem, he offers many discrete solutions that could be adopted and gives evidence, based upon research, of the likely outcomes. Our health system focuses on delivering medicine and procedures to deal with problems resulting in overtreatment, when it is clear that prevention, education, social services and promotion of lifestyle changes could be a much better bet. We are among the few countries (Mexico and South Korea are the others) that spend more on medical expenditures than social services.

It seems difficult to optimize health outcomes in the US, when profits and capitalism appears to be the greater goal. This book is informative and written in a manner that makes technical subjects very understandable.

Check it out.
2 people found this helpful
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Josh
5.0 out of 5 stars A new approach to health
Reviewed in the United States on April 8, 2019
Verified Purchase
Kaplan writes, convincingly, that much of our health care spending in the US is inefficient and ineffective. His proposal is to increase spending/research on the social and behavioral aspects of health instead.

As the country tends towards government-run health care, it’s important that we are mindful of this book.

“Observational data show that care delivery and spending vary dramatically across geography, but with no discernible effect on health” (p. 18) & “roughly a quarter of health care expenditures yield no benefit” (p.158). This is because of the informational asymmetry and government subsidy in health care: a doctor can overtreat or overprescribe since he/she knows best, and the patient goes along with it since insurance (often subsidized) covers most of the cost. This is especially poignant given that “medical errors [are] the third leading cause of death in the US” (p.82). The incentives in the health care system are not good.

Furthermore, “About half of what is published in scientific journals in incorrect [because of]... small samples... tiny experimental effects... frequent conflicts of interest... publication bias” (p. 46). Not only the doctors and patients, but the research scientists also have poor incentives to publish useless or harmful information. In addition, “we have good reason to believe that diminishing returns have set in” (p.55). His advice is to “expand social services, even if doing so might result in diverting resources from health care” (p.119).

In sum, we need to think more about health and less about health care.
One person found this helpful
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WBC
5.0 out of 5 stars "Find it Fix it" a model of health care in wide use - needs a new agenda
Reviewed in the United States on May 3, 2019
Verified Purchase
Dr. Kaplan systematically demonstrates the evidence that the United States leads in health care costs and lags in quality of care. Our life spans are shrinking while our health care costs are escalating and consuming too much of the budget of hard working individuals and Federal funding agencies. He suggests what can be done to remedy this and provides a cogent, fast paced, slim volume to show how. I recommend this book both to scholars who do any form of health care research as well those who deliver health care services and those who buy them. In other words - everybody. A major contribution by a preeminent scholar.
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JS
5.0 out of 5 stars Highly recommend!
Reviewed in the United States on March 24, 2019
Verified Purchase
This book provides a well written and documented history of medical research as well as insight regarding the politics of our current state of health care research. The author then offers an insider’s look at potential areas for improvement as the United States strives to provide better healthcare outcomes.
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