DOING BETTER AND FEELING WORSE: Health in the United States

A stimulating overview of contemporary medical issues that explores the major problems from a variety of perspectives, written by twenty practicing physicians and noted social scientists and edited by Rockefeller Foundation president John Knowles. Most challenge the broad definition of health enunciated by the WHO--Daniel Callahan calls it ""a bottomless conceptual pit""--and Eli Ginzburg says ""our national goals are too ambitious,"" promising more than can be delivered without distinguishing between rights and needs. Most agree also that the largest part of a doctor's time may be devoted to reassuring anxious patients (""the worried well""); perhaps a specified period as a GP should be part of every medical education. Other issues considered--and interrelated--are the ""movement toward effecting greater equality, collegiality, and accountability"" between doctor and patient; the ""technological imperative"" and the dilemmas it raises--cost factors, allocation priorities, and moral quandries such as the Quinlan case; medical education, performance measurement, and malpractice suit escalations; the importance of improving general education and refining preventive techniques; and, with an eye on Ivan Illich, recognizing the difference between structural demedicalization, which can be legislated, and cultural demedicalization, which can take generations to accomplish. Knowles himself, in a fine essay dramatizing the gap between learning about health risks and changing habits to accommodate them, examines the responsibilities of the patient. Tucked in are some astonishing statistics (prior to WW II the average per diem costs in New York City hospitals was $6.70) and some debatable assertions: ""the single most important factor associated with increased life expectancy is literacy."" A thoughtful, expansive collection of articles that questions unspoken assumptions and emphasizes the variables of health and health care.