100 Books Like Sickening

I found, as a history buff, The Struggle for Drug Reform to be an eye-opener about how America’s exceptionally high drug prices among other deficits in health care quality and coverage resulted from the past exercise of power by the pharmaceutical industry, the lynchpin of America’s “medico-industrial complex.”

I was impressed by historian Tobbell’s meticulously researched account of the industry’s strategic alliances with self-interested medical scientists, not just conservative political forces, and its use of anti-communist propaganda to fight off the threat of drug pricing regulations.

I personally found important her discussions of how the industry allied with the American Medical Association against universal health care, against FDA demands for evidence about drug efficacy and safety before allowing drugs on the market, and against the threat to its profits from generic drugs. 

I find Angell’s The Truth About the Drug Companies extremely valuable for teaching students about how the pharmaceutical industry translates high profits into power resources to protect and increase those profits over time.

The former New England Journal of Medicine editor exposed how drug companies enlist politicians, the FDA, and medical academia for their cause. And armies of lawyers to extend monopoly marketing rights for years.

It was my first introduction to how they spend more on marketing than research, much of that on “copy-cat” drugs of dubious superiority to ones with expired patents.

As a tax (and high drug price) payer, I was disturbed to learn how they use government funds for basic research and then rig and spin their reporting of clinical studies to inflate their products’ therapeutic value and underplay their risks. 

Kassirer, also like Angell a highly respected physician and former editor of the New England Journal of Medicine, first opened my eyes to how extensively drug companies use their vast wealth to turn physicians into promoters and middlemen.

I knew about the small and not-so-small gifts, speaking fees, travel junkets, and the like to individual doctors and “key opinion leaders” of the profession, but not about the “institutional conflicts of interest” gladly entered into by specialty medical societies heavily dependent on drug money for their events and activities such as scientific meetings, journal publishing, clinical practice recommendations, and, not least “continuing medical education” required by law for license maintenance.

Although Kassirer, also like Angell, proposed reforms, from what I know about conditions today, not much has changed, so On the Take remains an indispensable window into corrupted medicine. 

I was deeply impressed by how Psychiatry Under the Influence combines medical history, clinical knowledge, and investigative journalism about pervasive institutional conflicts of interest in medicine.

In Whitaker’s and Cosgrove’s case study of “institutional corruption” they trace the development over time of an alignment of the psychiatric profession’s “guild interests” in turf maximization and scientific legitimation with drug companies’ drive to market a widening array of drugs massively profitable drugs.

It is a fascinating illustration of the medicalization of life resulting from what I would call the “commercial construction of disease.”

Particularly eye-opening was the role of the American Psychiatric Association in constructing pseudo-scientific diagnostic categories of psychoses, panics, anxieties, depressive states, and the like for drug companies to capitalize on—and concealing, distorting, and fabricating research results that facilitate mass overprescribing of potentially harm-causing drugs.

John Wennberg is a medical doctor and researcher who has spent much of the last half century analyzing the practice of medicine across the United States.

He has used Medicare patients’ treatment records to show that health delivery is often more dependent on the supply of providers and facilities in an area than the expected demand for such treatment of the area population.

He and his associates have also shown that more intensive treatment generally does not result in better care and sometimes leads to more adverse outcomes.

Two pharmacists sit in a Boston courtroom accused of murder. The weapon: a fungus. The death count: 100 and rising. These facts set the stage for a true-crime thriller by investigative journalist Jason Dearen, and it has the makings of a horror movie. There’s scientific hubris, sketchy ethics, a cover-up, and a monster, too: a slimy, sticky, fungal mold that infected patients and began eating their brains alive. It’s riveting, packed with information about how fungal spores managed to contaminate a medical supply chain, and frankly hard to put down. I have done my share of forensic research, and never have I encountered killer fungus before; I consider this an unmissable book.

Dr. Makary begins with an almost unreal story of a French citizen who had the unfortunate luck of having a heart attack in the US. I won’t give it away, but used car dealers come out smelling like roses, and I did that for a while, back in my youth. Such a lesson. Americans sorely need perspective on what great care is and how to pay for it. Dr. Makary does a fantastic job outlining two little-known middlemen sucking money out of American wallets. Pharmacy Benefit Managers, and Group Purchasing Organizations. Both use tactics that would make Tony Soprano smile.

What I love about this book, and why I recommend it, is while spotlighting problems, he offers solutions, and spotlights people making a difference.

Ever hear of MLR or Medical Loss Ratio? I had, but it didn’t click why it was a cruel joke on American healthcare consumers until I read Marshall’s book. His give a kid a bowl of ice cream analogy is so spot on that I asked for and received his permission to quote it in my book. My dad used to say that a sure sign of genius is making a complex subject understandable to an eighth grader. Marshall’s a genius. His insights stem from over 15 years of investigative reporting on the healthcare industry are critical to combatting a downright evil billing system. Whenever a friend mentions they’ve been in the hospital, or will be, I tell them to read this book. 

One prevailing theory about the high cost of U.S. health care compared to other highly developed nations is that the prices charged for goods and services are simply higher in the United States and elsewhere.

Reinhardt is one of the leading proponents of this school of thought and this book summarizes his reasoning on the subject and how to deal with it.

I absolutely loved the simplicity and clarity of this approach.

It’s almost the opposite end of the spectrum to my first selection and a method that I found more and more common over the years of my career: checklists and flowcharts for the serious and frequent presentations in the Emergency Department, in the operating theatre, and at Triage. And Gawande was right: they did and do save lives.

More generally, I used this process all the time when I was training other staff in my posts with Doctors Without Borders. Preventing and avoiding problems with fail-safe systems is so much better than trying to solve them after they occur!