More than Medicine: The Broken Promise of American Health

by Robert M. Kaplan

Overview

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.

Product Details

ISBN-13:	9780674975903
Publisher:	Harvard University Press
Publication date:	02/04/2019
Pages:	240
Product dimensions:	5.70(w) x 8.30(h) x 1.00(d)

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.

Table of Contents

Introduction 3

1 Let's Be Average 9

2 Research Promise and Practice 29

3 Mistaking the Meaning of Health 58

4 Making Health Care Safe and Effective 80

5 Social Determinants of Health 95

6 The Act of Well-Being 121

7 A Way Forward 141

Appendix 169

Notes 175

Acknowledgments 209

Credits 213

Index 215

Editorial Reviews

11/12/2018
Kaplan, director of research at the Stanford School of Medicine Clinical Excellence Research Center, argues the U.S. health care system is failing because “we measure the wrong things,” like cholesterol and other biomarkers, rather than focusing on overall wellness. Now “deeply invested” in expensive biomedical research, the U.S. spends more on health services than other developed nations—$3.2 trillion in 2017—yet Americans have shorter life expectancies and higher infant mortality rates than the populations of those countries. Kaplan blames overinvestment in “moonshot” medicine—the Human Genome Project, for example, and the National Children’s Study approved during the Clinton administration—as well as stem cell and gene therapy research, noting that “by 2012, more than 1,800 gene therapy trials were ongoing, but no cures had materialized.” Kaplan attempts too broad a critique of the health-care system, branching out into discussions of the flaws of peer review research, the problems with medical clinical trials, and diagnostic errors among physicians. Nonetheless, 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. (Feb.)

Publishers Weekly

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

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

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

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. Jarvisn Interest

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.

Wall Street Journal - Chris Pope

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

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.

American Interest - Joseph Q. Jarvis

2018-11-13

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.

Kirkus Reviews