As a physician with a public health background, I have a healthy amount of scepticism when 'the next great book' comes along and claims to change the way we live. However, while reading Goetz' book, it didn't take long for me to realize I was in for a wonderful surprise. Perhaps it is his background as an editor at Wired magazine that makes his writing so engaging. Combine that with a solid grounding in the public health arena and the result is impressive. Although written with the patient in mind, this book will serve as an invalubale tool for clinical practitioners and epidemiologists alike. It opens a window into the field of medicine that I found fascinating and highly educational. More importantly, it gives us a glimpse at the way the doctor-patient relationship will look in the future. And, whether we like it or not, as Goetz eloquently reminds us, we would be wise to take notice now.
When it comes to assessing the problems with our health care system and identifying ways to make it better, this book by Thomas Goetz is among the best I've ever read. Hopefully, it will be highly influential, especially considering that we live in an age when most of the "easy" medical problems have been solved and the hard ones remain (eg, cancer and many chronic conditions). Goetz proves to be an incisive analyst, a creative thinker, a balanced pragmatist, and a lucid writer.
The main idea presented in this book is that decision tools need to be developed which enable all available information to be rationally, systematically, and efficiently assembled and weighed in order to cost-effectively maximize individual and collective health outcomes. In other words, health care needs an engineering approach. This is really just common sense, yet our health care system unfortunately falls far short of this ideal, so we need books like this to help open people's eyes.
Here are some further key points from the book:
* Patients need to play an active role in their health care decisions, using physicians and other health care professionals largely as consultants, and collaborating with other patients in sharing information.
* Health care information (medical records, drug labels, etc.) needs to be presented in a sensible standardized format and made easily accessible online on a real-time basis.
* To account for biological heterogeneity among people, preventive measures and treatments need to be tailored to each individual. Thus, the information used to make decisions must include both statistical information drawn from populations as well as specific information particular to each individual (both phenotypic and genetic).
* Costs need to be controlled by emphasizing prevention of disease, lowering the cost for FDA drug approval, avoiding replacement of older/cheap drugs with newer/expensive drugs which aren't significantly better, avoiding use of expensive drugs which don't significantly improve outcomes (eg, many cancer drugs), using/avoiding screening based on relationship to outcomes, avoiding overuse of expensive medical technology, and linking physician payments at least partly to outcomes rather than extent of services.
The above ideas overlap considerably with ideas I arrived at myself after years of intense involvement with health care issues (especially related to cancer research and treatment). For example, see my detailed review of The War on Cancer: An anatomy of failure, A blueprint for the future by Guy Faguet.
This is a brilliant and important book, and I can't recommend it strongly enough.
Buy The Decision Tree: How to make better choices and take control of your health Now
Thomas Goetz catalogs the recent advances (and setbacks) in medicine & personal health, but also maps out the possibilities for how things could get better. He does this so convincingly that you can't believe it's not already taking root: clear labeling on drugs & food, passive tracking of our exercise routines, open access to our health data.
There are enough lessons for self-improvement in the book that I found myself comparing it to What to Expect When You're Expecting, but since Goetz focuses on the big picture (prevention, diagnosis, disease management) it is more like What to Expect When You're Expecting a Long Life.
Unlike the pregnancy bible I read 10 years ago (and more than once threw across the room), Goetz doesn't preach from a lofty whole-grain pulpit. He doesn't think we should ask people to do more, nor should we scold people for every mistake they have made, but rather we should give them tools to make better health choices.
You know how MDs are always asked for cocktail-party diagnoses? This book is for all the MPHs who stood nearby wishing that someone would ask them for on-the-spot health advice.
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I found this book interesting. The first couple of chapters were a bit slow for me because for the few new things I learned, they were repeated several times. As a matter of fact, the author repeats the theme of taking control of your health early throughout the book. I did learn some interesting things, like why so many pharmaceutical companies abandon research that might seem promising they simply don't stand to make enough money. The author says they want to make at least 1 billion dollars per cure, so they abandon the ideas that might only generate a few hundred million. The book has a lot of interesting ideas like that in it, but ultimately it doesn't come to a prescriptive method for taking control of your health. While it is called the Decision Tree and there are several examples of Decision Trees in the book, it doesn't ultimately result in "the" decision tree. However, it does mention several potentially useful websites throughout, such as 23andme, patientslikeme, curetogether, and several others. I only investigated 23andme and the price for genetic sequencing looks to have gone down to $299. Anyways, this is an interesting book and once I got through the first couple of chapters I read through it rather quickly. The author clearly did his research and the effort shows. However, you will not find any magic fomula for managing your health in this book. Instead, you will find lots of suggestions, examples about people who already have issues and their decision trees, and some complaints (I think very legitimate ones) about the way health care is administered today.
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This book is an enjoyable foray into making better medical decisions and taking control of one's health care. The author uses several stories of how people with illnesses were able to make better health decisions by obtaining better testing-mostly genetic or linking to social networking sites on health. The authors writing is captivating and has lots of information and insights into the problems of modern medicine. I find the authors theories of decisionmaking undertheorized and though based on tests he could have mentioned what to do next if treatments based on genetic tests dont work. This is of critical importance for as the author acknowledges many treatments dont work. He could have mention adaptive interventions, evolutionary algorithms, or other problem solving methods. Still, a good effort and worth reading.
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Being a student of rainforest medicinal plants myself, I found this book one of the best, published or unpublished, to-date. The drawings are excellent, making field identification easy. The presentation of both the common and scientific names of plants is invaluable. I found it interesting that the Carribean people of Belize and the Carribean people of Costa Rica (where I am) use the same names and uses for many of the medicinal plants. This book is a wealth of information for such a small price, not to mention, motivation for further inquiry. Thank You!
