Worried Sick: How Vulnerable Are You Really to Heart Attack, Stroke or Breast Cancer?

By Maggie Mahar, Health Beat. Posted November 27, 2008.

At the same time, Hadler knows how fallible medical science is. A student of Karl Popper, the philosopher of science who taught that "truth is only the hypothesis that is yet to be disproved," Hadler knows that today's received wisdom may be replaced tomorrow.

Not long ago, he points out "tonsils were removed because they were swollen and uteruses because they were lumpy." We were wrong. Throughout the 1990s, oncologists thought that bone-marrow transplants would help breast cancer patients -- and thousands of women suffered needlessly. More recently, we are realizing that when you consider the risks as well as the benefits, we may have been overly optimistic about mammograms as the answer to breast cancer. A few women are saved; many others are hurt. Or as an Australian study declared not long ago: "Benefits and harms of screening mammography are relatively finely balanced." 

Until quite recently, the National Cancer Institute and the American Cancer Society recommended PSA testing for early-stage prostate cancer for average-risk men over 50. Now, they don't.

In medicine, scientific progress is not simply a matter of accumulating of knowledge. Often, advances mean unlearning what we thought we knew -- and replacing that knowledge with a new, temporary truth. Sometimes the new truth is misleading; sometimes it will apply only to some patients. Always, we have to be ready to see it replaced.                 

Hadler explains that he wrote Worried Sick, not for people who are seriously ill, but for the "worried well." Hadler wants to help us cope with knowing that we are mortal without letting the fear of death shadow our lives as we fret over each and every symptom -- be it "heartburn, a peculiar sensation or a realization of our physical limits."

His goal is "bolster the personal resources that facilitate coping" with the ills that flesh is heir to. "And our coping is in dreadful need of bolstering," he adds. "The wealth of information disseminated by all sorts of health care vendors, including those in the medical profession, may be intended as helpful but often is not. Much of this information does violence to our sense of invincibility without doing equivalent good for our health or longevity...

"Your sense of well-being requires conviction to withstand the badgering assaults of health-promotion programs," Hadler adds.  "Yes, we will all die. The issue for me is not so much how or why we die, but when and how we lived." But in our health care system, and in the mind of the laymen, "the proximate cause of death is foremost, so that great energy and great wealth is expended trying to spare you death from a particular cause without considering whether you will die at the same time from some other cause. "

Ultimately, Hadler wants to help us cope with not being perfectly well -- and knowing that we are mortal without being "worried to death" about dying. "No one should be as concerned about the proximate cause of their demise as they are about the likelihood their course in life will be satisfying. It matters little what carries one off, as long as it was her or his time and the journey was gratifying."

See more stories tagged with: health, risk, breast cancer, stroke, heart attack

Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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