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  • Acknowledgments ix

    Introduction. Diagnosing Twenty-First-Century Health Care 1

    Part I: The Quandry and Unexamined Ordinariness of Twenty-First-Century Medicine

    1. Ordinary Medicine in Our Aging Society: The Dilemma of Longevity 21

    Part II. The Chain of Health Care Drivers

     2. The Medical-Industrial Complex I: Evidence-Based Medicine, the Biomedical Economy, and the Ascendance of Clinical Trials 53

    3. The Medical-Industrial Complex II: Access, Industry, and the Clincial Trials Phenomenon 79

    4. "Reimbursement Is Critical for Everything": Medicare and the Ethics of Managing Life 99

    Part III: Medicine's Changing Means and Ends

    5. Standard and Necessary Treatments: The Changing Means and Ends of Technology 127

    6. Family Matters: Kidneys and New Forms of Care 165

    7. Influencing the Character of the Future: Prognosis, Risk, and Time Left 195

    8. For Whose Benefit? Our Shared Quandary 217

    Conclusion. Toward a New Social Contract? 238

    Notes on the Research 249

    Notes 255

    Bibliography 285

    Index  307
  • Honorable Mention, Diana Forsythe Prize, presented by the Society for the Anthropology of Wark (SAW) section of the American Anthropological Association and the Committee on the Anthropology of Science, Technology, and Computing (CASTAC)

  • “Medical anthropologist Kaufman bravely delves into the heartbreaking predicament of modern medicine: ‘getting the medicine we wish for but then having to live with the unsettling and far-ranging consequences.’ … Kaufman is at her best when focusing on the heartbreaking dilemma of patients dealing with the consequences of ordinary medicine, such as an elderly patient who must choose between lifesaving treatments or palliative care, facing repeated hospital visits regardless of the choice. Kaufman calls for no less than making the ethics of medicine the ‘preeminent topic of our national conversation about health care reform.’”

    “What makes Kaufman's analysis distinctive is the way she demonstrates the effects of Medicare policy on treatment benefits—namely, if a patient on Medicare is eligible for treatment, providers are often willing to supply it. But the author notes that this way of thinking has led us to stop examining issues around quality of life, obligations to our families, and the inevitable prospect that we will die. Health-care professionals, students of medical ethics, and others interested in the actions that frame American medicine will find this a thought-provoking read."

    “If Gawande’s is the voice of comfort, and simple yet vital solutions, Sharon Kaufman’s brings her characteristic analytic and ethical precision, eschewing easy answers for an assessment of the structural density of our current predicament. Anyone who has read her earlier book on end-of-life care in American hospitals, And a Time to Die: How American Hospitals Shape the End of Life, will be familiar with her tremendous ability to narrate the ambiguities of American medicine as it unfolds on the ground via the stories of people who are caught up in its contradictions.”

    "The elegant part of Kaufman’s analysis—of a kind maybe only a sharp-eyed anthropologist with a wide lens can provide—concerns the way we all become unwitting victims of the chain, wrapped tightly around us.... Is there any good news here? Yes, Sharon Kaufman has written a wonderful, necessary, and readable book, and that is a start."

    "Fascinating.... The book is written in a lucid and highly readable style, case studies of patients bringing the ‘health care system’ vividly alive through thick description.... The ethical dilemmas, small and large simultaneously, gripped me such that on two consecutive readings I found myself sitting up late into the night unable to put it down."  

    "Kaufman delivers a haunting and provocative meditation on the peculiarly American obsession with highly technologized longevity. Through a combination of historical analyses of debates in health policy and health economics, bioethical argumentation, and powerful ethnographic examples, Kaufman meticulously demonstrates the rise over the past few decades of what she calls ordinary medicine.... Kaufman’s book constitutes an important and troubling addition to current bioethical debates on health financing and the distribution of medical resources. At its heart, this book seems to be about how and why US health care costs have spiraled out of control—a topic of great timeliness and political interest."

    "A must read for all practitioners and people experiencing the end of life.... Kaufman does a good job discussing the four outside issues that impact medicine today: the biomedical research industry, which pours out expensive new treatments; the determination of what treatments will be ordered according to what insurance or Medicare will reimburse for; evidence supporting a treatment’s use, causing it to become standard care for all; and the ethical imperative that if something is standard, everyone should receive it. Kaufman also provides several scenarios and an extensive bibliography. This book should be required reading for every health care provider.  Highly recommended. Upper-division undergraduates through professionals/practitioners" 

    "The strengths of this revealing study derive from Kaufman’s analysis of the chain of drivers that creates unprecedented growth in medical treatments; compelling evidence from case studies; multiple perspectives of physicians and other health care personnel, patients, and their families; and the questions raised about drawing the line. This book will create a deeper understanding of the expanding possibilities for medical treatments and the implications for the health care system."

    "[T]his is a book whose moral passion is palpable, and admirable for just that reason, as well as for its excellent scholarship. Yet, it is Kaufman’s careful, insightful observations that carry us beyond her undeniably excellent analysis."

    "[T]his book was a fascinating read. While many components have been examined previously, they are typically studied in isolation or less comprehensively. This book is distinguished by the author’s ability to bring so many pieces of the puzzle together in one place, allowing for connections to be drawn and implications to emerge that are more than just the sum of the different parts.... Ordinary Medicine is an important contribution that will have broad appeal and be of value to students at all levels, academics, policy-makers, and even the general public; especially those with an interest in science and technology, an aging population, or health care."

     

    "This provocative, engrossing book will make a valuable addition to undergraduate and graduate courses in anthropology, sociology, public health, and public policy, including those in medical anthropology and sociology, science and technology studies, bioethics, the nature of U.S. health care, aging and dying, and visions of personhood and the life course. Beyond the classroom, the book should also be read by physicians, health care policymakers, medical ethicists, and an educated public wishing to rethink and renew medicine’s goals."
     

    "Overall, Kaufman’s latest book is moving to read and sets out the dilemmas of aging and dying within the American healthcare system.... I would recommend that anthropologists and healthcare professionals read her book to reflect on the healthcare practices they are part of and observe."

    Awards

  • Honorable Mention, Diana Forsythe Prize, presented by the Society for the Anthropology of Wark (SAW) section of the American Anthropological Association and the Committee on the Anthropology of Science, Technology, and Computing (CASTAC)

  • Reviews

  • “Medical anthropologist Kaufman bravely delves into the heartbreaking predicament of modern medicine: ‘getting the medicine we wish for but then having to live with the unsettling and far-ranging consequences.’ … Kaufman is at her best when focusing on the heartbreaking dilemma of patients dealing with the consequences of ordinary medicine, such as an elderly patient who must choose between lifesaving treatments or palliative care, facing repeated hospital visits regardless of the choice. Kaufman calls for no less than making the ethics of medicine the ‘preeminent topic of our national conversation about health care reform.’”

    “What makes Kaufman's analysis distinctive is the way she demonstrates the effects of Medicare policy on treatment benefits—namely, if a patient on Medicare is eligible for treatment, providers are often willing to supply it. But the author notes that this way of thinking has led us to stop examining issues around quality of life, obligations to our families, and the inevitable prospect that we will die. Health-care professionals, students of medical ethics, and others interested in the actions that frame American medicine will find this a thought-provoking read."

    “If Gawande’s is the voice of comfort, and simple yet vital solutions, Sharon Kaufman’s brings her characteristic analytic and ethical precision, eschewing easy answers for an assessment of the structural density of our current predicament. Anyone who has read her earlier book on end-of-life care in American hospitals, And a Time to Die: How American Hospitals Shape the End of Life, will be familiar with her tremendous ability to narrate the ambiguities of American medicine as it unfolds on the ground via the stories of people who are caught up in its contradictions.”

    "The elegant part of Kaufman’s analysis—of a kind maybe only a sharp-eyed anthropologist with a wide lens can provide—concerns the way we all become unwitting victims of the chain, wrapped tightly around us.... Is there any good news here? Yes, Sharon Kaufman has written a wonderful, necessary, and readable book, and that is a start."

    "Fascinating.... The book is written in a lucid and highly readable style, case studies of patients bringing the ‘health care system’ vividly alive through thick description.... The ethical dilemmas, small and large simultaneously, gripped me such that on two consecutive readings I found myself sitting up late into the night unable to put it down."  

    "Kaufman delivers a haunting and provocative meditation on the peculiarly American obsession with highly technologized longevity. Through a combination of historical analyses of debates in health policy and health economics, bioethical argumentation, and powerful ethnographic examples, Kaufman meticulously demonstrates the rise over the past few decades of what she calls ordinary medicine.... Kaufman’s book constitutes an important and troubling addition to current bioethical debates on health financing and the distribution of medical resources. At its heart, this book seems to be about how and why US health care costs have spiraled out of control—a topic of great timeliness and political interest."

    "A must read for all practitioners and people experiencing the end of life.... Kaufman does a good job discussing the four outside issues that impact medicine today: the biomedical research industry, which pours out expensive new treatments; the determination of what treatments will be ordered according to what insurance or Medicare will reimburse for; evidence supporting a treatment’s use, causing it to become standard care for all; and the ethical imperative that if something is standard, everyone should receive it. Kaufman also provides several scenarios and an extensive bibliography. This book should be required reading for every health care provider.  Highly recommended. Upper-division undergraduates through professionals/practitioners" 

    "The strengths of this revealing study derive from Kaufman’s analysis of the chain of drivers that creates unprecedented growth in medical treatments; compelling evidence from case studies; multiple perspectives of physicians and other health care personnel, patients, and their families; and the questions raised about drawing the line. This book will create a deeper understanding of the expanding possibilities for medical treatments and the implications for the health care system."

    "[T]his is a book whose moral passion is palpable, and admirable for just that reason, as well as for its excellent scholarship. Yet, it is Kaufman’s careful, insightful observations that carry us beyond her undeniably excellent analysis."

    "[T]his book was a fascinating read. While many components have been examined previously, they are typically studied in isolation or less comprehensively. This book is distinguished by the author’s ability to bring so many pieces of the puzzle together in one place, allowing for connections to be drawn and implications to emerge that are more than just the sum of the different parts.... Ordinary Medicine is an important contribution that will have broad appeal and be of value to students at all levels, academics, policy-makers, and even the general public; especially those with an interest in science and technology, an aging population, or health care."

     

    "This provocative, engrossing book will make a valuable addition to undergraduate and graduate courses in anthropology, sociology, public health, and public policy, including those in medical anthropology and sociology, science and technology studies, bioethics, the nature of U.S. health care, aging and dying, and visions of personhood and the life course. Beyond the classroom, the book should also be read by physicians, health care policymakers, medical ethicists, and an educated public wishing to rethink and renew medicine’s goals."
     

    "Overall, Kaufman’s latest book is moving to read and sets out the dilemmas of aging and dying within the American healthcare system.... I would recommend that anthropologists and healthcare professionals read her book to reflect on the healthcare practices they are part of and observe."

  • "Sharon R. Kaufman has made an important and disturbing discovery about the links between for-profit healthcare companies, so-called evidence-based medicine, doctors, and patients. Ordinary Medicine should be read, thought about, and acted upon by those who have the power to effect change."
      — Victoria Sweet, author of God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

    "I devoured Ordinary Medicine. It gave me courage. It helped me delineate, sometimes for the first time, the interlocking forces and practices that have helped create an epidemic of unnecessary suffering at the end of life. Breathtaking in its scope, rigor, and intellectual range, this book will help readers take back control of their lives and deaths from the forces that have created an 'ordinary' end-of-life medicine that is far from ordinary." — Katy Butler, author of Knocking on Heaven's Door: The Path to a Better Way of Death

    "Ordinary Medicine is an exploration of how what is essentially experimental medicine can become 'standard care.'  In this thoroughly researched book, many of our assumptions are shaken. The system that is extant would seem aligned to prevent us from accepting death as a natural life progression and offering in its place prolonged suffering. A truly engaging and provocative read." — Abraham Verghese, author of Cutting for Stone

    "The recommendation by the AMA to Medicare to begin paying physicians for discussions with patients about end-of-life care makes this new book by Sharon Kaufman particularly timely. She explains why the present health care system is biased toward excess treatment at the end of life, and advocates a broad approach to health care reforms that goes beyond cost control to encompass social and ethical considerations." — Victor R. Fuchs, author of How We Live

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  • Description

    Most of us want and expect medicine’s miracles to extend our lives. In today’s aging society, however, the line between life-giving therapies and too much treatment is hard to see—it’s being obscured by a perfect storm created by the pharmaceutical and biomedical industries, along with insurance companies. In Ordinary Medicine Sharon R. Kaufman investigates what drives that storm’s “more is better” approach to medicine: a nearly invisible chain of social, economic, and bureaucratic forces that has made once-extraordinary treatments seem ordinary, necessary, and desirable. Since 2002 Kaufman has listened to hundreds of older patients, their physicians and family members express their hopes, fears, and reasoning as they faced the line between enough and too much intervention. Their stories anchor Ordinary Medicine. Today’s medicine, Kaufman contends, shapes nearly every American’s experience of growing older, and ultimately medicine is undermining its own ability to function as a social good. Kaufman’s careful mapping of the sources of our health care dilemmas should make it far easier to rethink and renew medicine’s goals.

    About The Author(s)

    Sharon R. Kaufman is Chair of the Department of Anthropology, History and Social Medicine at the University of California, San Francisco. She is the author of …And a Time to Die: How American Hospitals Shape the End of Life.
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