MORE THAN MEDICINE

An argument for redirecting health care funding in the United States, concentrating less on biomedical research and more on social services, thereby improving our general health and preventing overspending.

In the U.S., we spend considerably more on developing expensive medical treatments compared to other economically advanced countries, yet we often fall behind in terms of life expectancy and quality of life. So argues Kaplan (Director of Research/Stanford School of Medicine Clinical Excellence Research Center; The Prophet of Psychiatry: In Search of Reginald Ellery, 2015, etc.) in this slim but comprehensive new book. The author rigorously investigates some of the cutting-edge research areas—e.g., genetic therapy and precision medicine—funded by the National Institutes of Health (where the author was a chief science officer) and influenced by the financial interests of the pharmaceutical industry. He concludes that the promise of generating astounding cures for particular medical problems is considerably stronger than the practice. He appeals for increased funding for improved quality-of-health care that could save thousands of lives, citing the increased number of deaths each year due to poor treatment and medical errors (the third-leading cause of death behind heart disease and cancer). Kaplan further considers issues around race, financial inequality, and lack of education, pointing to the increased death rates in more impoverished parts of the country where medicine has done little to improve health outcomes. Ultimately, the author is not opposed to biomedicine, but he seeks urgent reforms in how we allocate funding. “It is not my contention that biomedicine is inherently harmful or useless. Far from it,” he writes. “It is my contention that researchers and the wider citizenry should continually debate strategies for extracting public benefit from scientific knowledge. I believe that an open debate, accountable to the latest evidence, will inspire significant reforms.”

Sharp, authoritative, and intensely data-driven. Though it reads like an expanded article for a professional medical journal, the argument is deeply compelling.