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Bad medicine and what can be done about it

At 22, Jennifer Rufer yearned for a big family.

Then blood tests indicated the Seattle woman had uterine cancer. Chemotherapy failed to stem the disease, so she had a hysterectomy. Part of her lung was removed out of concern that the cancer had spread. Still, the tests -- 44 in all -- were bad. Shrinking from weight loss, she posed with her husband at Christmas for what both assumed would be their last holiday photo.

But a new test showed in 2001 that the earlier results had been false positives. Rufer never had cancer. A lawsuit made her a millionaire. Nothing, unfortunately, could ever make her what she longed to be, a birth mother.

This was an extreme example of an all too common problem, Richard Deyo and Donald Patrick write in ''Hope or Hype," a relentless indictment of the business of American medicine. At best, they contend, too much healthcare is ineffective, squandering precious dollars. At worst, as in Rufer's case, the care can be downright hazardous.

Business is partly to blame, according to the authors, a doctor and health services professor, respectively, at the University of Washington. Too often, physicians and the makers of drugs and medical devices cut sweetheart deals in which the manufacturers ply doctors with gifts or ''consulting" fees in exchange for using their products, regardless of their superiority.

But the rest of us are on the hook: patients, for simultaneously demanding inexpensive care and the latest, priciest treatments, even if they're unproved; insurance companies, which aren't rigorous enough in insisting that coverage go for documented effective treatments; and the government, which permits all this.

The growth of modestly effective but costly treatments ''is the main reason why health insurance costs are rising so fast, with so little to show for it in terms of longevity or other public health statistics" in which other industrialized nations outdo us, according to the authors.

Written in plain if often unexciting English, ''Hope or Hype" doubtless is too wonkish for some readers. But those for whom talk of HMOs and PPOs is like a heavenly chorus will find much to ponder in this encyclopedic dissection of an undeniably life-or-death topic. And personal stories like Rufer's animate the chin-scratching analysis with real people.

The authors suggest an array of fixes, starting with evidence-based medicine, by which they mean treatments, drugs, and devices that have been run through the scientific colander of randomized trials. Readers who assume medicine is already based on evidence will be stunned to learn the flimsy science undergirding those alleged miracle drugs advertised on TV or even some treatments prescribed in good faith by their family physician.

'' 'Science' has often meant inferences drawn from what we know of human physiology and disease behavior, information from studies of animals, or expert opinions," the authors write.

Or, as the doctor says to his patient in one of the many amusing cartoons reproduced in the book, ''Take these pills three times a day, unless you read in the paper that they've been proven ineffective."

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