Hippocrates' Shadow

by David H. Newman

"Aclear-sighted, heartfelt, and humane story of the needless tests and treatments that cripple healthcare....as a guide to good medicine, it may help us get back to the essence of what good doctors do: be with patients in healing." —Samuel Shem, M.D., author of The House of God and The Spirit of the Place

In Hippocrates’ Shadow, Dr. David H. Newman upends our understanding of the doctor-patient relationship and offers a new paradigm of honesty and communication. He sees a disregard for the healing power of the bond that originated with Hippocrates, and, ultimately, a disconnect between doctors and their oath to"do no harm."

Exposing the patterns of secrecy and habit in modern medicine’s carefully protected subculture, Dr. Newman argues that doctors and patients cling to tradition and yield to demands for pills or tests. Citing fascinating studies that show why antibiotics for sore throats are almost always unnecessary; how cough syrup is rarely more effective than a sugar pill; and why CPR is violent, invasive—and almost always futile, this thought-provoking book cuts to the heart of what really works, and what doesn’t, in medicine.

Genres: Medicine, Medical, Nonfiction, Health, Science, Health Care

272 pages, Paperback

First published January 1, 2008

Reviews

[Lena · Rating 4 out of 5]

I hadn't expected a book examining problems with modern medicine to be such a page-turner, but the author lived up to his promise to reveal "secrets from the house of medicine," and some of them are doozies.

David Newman is a specialist in emergency medicine, and he combines stories from his practice with hard data to highlight the many places where things can go wrong in the doctor-patient relationship. In chapters with titles such as "We Don't Know," "It Doesn’t Work," and "We Don't Agree," Newman reveals that modern medicine is still very much in its infancy, and he makes a compelling argument that the practice of good doctoring requires not just science but also a significant amount of art. Newman talks at length about how this more human side of medicine has been lost in a flurry of often unnecessary tests and procedures and discusses how this focus contributes to the decline of satisfaction of not just patients but also of doctors themselves.

Throughout the course of the book, Newman gives numerous fascinating examples of medical interventions that are proven ineffective and yet still routinely given, and this education alone was for me worth the price of the book. I walked away from it with a much better understanding of what my doctors can and can't do for me, how medical decisions are made, more realistic expectations of the results I may get, and more confidence to be an active participant in my own health care decisions.

I found all of the above so valuable I was all set to give this book five stars when Newman made an abrupt left turn in the last chapter that gave me serious pause. Specifically, he comes to the conclusion that the problems of modern medicine are the result of a near religious belief in science. Though this makes sense in the context of doctors paying more attention to unreliable and subjective diagnostic tests than patients themselves, it directly contradicts the numerous examples he gives of doctors making poor treatment choices because they are blatantly ignoring hard scientific data that contradicts their long-established beliefs. Given how complex the problems woven into our medical system are, I can understand Newman's desire to end the book with a simple summary of a core problem. But in ending the book with such a broad swipe at science, he diminishes the numerous other problems he so eloquently outlined earlier in the book in favor of the kind of black and white answer he had done such a good job of showing us it is unrealistic to expect.

[Sandi · Rating 3 out of 5]

One of the problems I often have with non-fiction is that it has a tendency to wander, get bogged down in minutiae, and/or come across sounding like a textbook. David Newman is an excellent writer who manages to get his points across in an engaging manner. "Hippocrates' Shadow" is a quick, informative read that doesn't get bogged down in a lot of techno-babble. I would give it four stars because I think people really should read it, but my personal rating is three stars because I had already come to many of the conclusions that Newman did based on my own encounters with the medical system. I think people need to know the information this book contains, but I also think it doesn't go far enough. Here is what I think is missing or shortchanged:

1. The current insurance system in the U.S. has made it practically impossible for modern doctors to practice medicine they way doctors did in the past. (Newman spends about 3 pages in the last chapter talking about how the system is broken, but doesn't go into much detail.) Today, a doctor spends somewhere from 5-10 minutes with each patient. That's just not enough time to get to the bottom of the patient's complaint, much less get to know more about the patient and their lives. Heck, they don't even have time to review patients' charts before entering the examining room.

2. Newman talks about how doctors like tests. What he misses is that there are many times that tests that could be beneficial are not given because they need to keep costs down for the insurance companies.

3. Newman doesn't talk about the patient's role in health care, or when he does it's negative. He does mention that a patient could ask for a test or a treatment, but in the context he uses it, the patient is mis-informed. In my experience, a patient HAS to now the possible diagnoses and treatments for his/her condition. He or she may be wrong, but they have to be well-informed before going into the doctor's office so they can discuss the situation intelligently. When doctors (even specialists) only spend 5-10 minutes with each patient, things are going to be missed. Newman misses that modern medicine needs to be a partnership between doctors and patients. Doctors a human and subject to the same limits of knowledge and experience as any other humans.

4. Newman doesn't offer any suggestions for the reader to help overcome the problems he sees with modern medicine. He makes everything sound really hopeless. He doesn't offer examples of doctors doing things right. It just seems like everything about medicine is broken and there's nothing that can be done about it. While it's true that the system is broken, I have found that being an informed patient makes a world of difference. Knowing that doctors don't know everything and are fallible helps the patient take proactive steps in their medical care. Knowing that doctors are human allows the patient to change doctors without guilt when they don't connect on a human level with that doctor.

I thought "Hippocrates' Shadow" was very good in what it did cover. However, it was incomplete and should have covered a bit more.

[Daniel · Rating 1 out of 5]

what a frustrating and miserable book. it was about a hundred pages too long, with plenty of filler in the form of redundant straw man bashing and self-congratulatory vignettes which serve no purpose other than to demonstrate how exceptional and wise a doctor newman sees himself as. hippocrates himself if barely mentioned, save for a sentence or two at the end of the chapter which feebly and futily attempts to relate newman's self-aggrandizing diatribes to some idealistic dogma which he conveniently leaves undefined. please don't waste your time with this. if you must, read the first three chapters (what i'm assuming was the proposal) and skip the rest.

[Mazola1 · Rating 3 out of 5]

Hippocrates' Shadow is a modern doctor's somehat skeptical (some might say amost cynical) look at modern medicine. Some of its "secrets" aren't really that secret, i.e., that antibiotics are overprescribed because patients demand them and doctors find it quicker and easier to go ahead and bow to their wishes. Newman also contends that CPR doesn't work, mammograms and PSA tests don't save lives, lab tests are over ordered and often misinterpreted, most x-rays tell doctors things they already know, doctors aren't taught how to communicate with their patients, and don't spend enough time talking and listening to them. By the end of the book, I found myself wondering why anyone goes to the doctor at all.

Newman believes that modern medical education and practice cause doctors to spend too much of their time ordering and reviewing tests, and far too little on patient contact. As he says, "This pattern of patient avoidance is an integral part of a modern medical system that is at least partly responsible for substantial increases in longevity and improved quality of life. But it is also a key contributor to decreasing patient satisfaction and increasing alienation. One of the greatest secrets of modern health care is, therefore, the lack of care. In hospital, where virtually all paradigm building and modern training occurs, a tiny fraction of a physician's day is spent seeing, touching, or talking to patients."

Newman's prescription for how to fix what ails modern medicine is to return to the wisdom of Hipprocates. According to Newman, Hipprocates practiced medicine as an Art first, not as a science, and "first and foremost respected his patients, placing them above all other considerations." He praises Hipprocates as a "holistic practitioner intent on treating the complete person, whereas today we tend to specialize in exquisitely narrow fields of anatomic and physiologic knowledge..."

Newman compares modern doctors unfavorably to Hippocrates: Hippocrates was a "consummate communicator," but today's doctors are "walking communication nightmares." Hippocrates was sympathetic, while modern doctors are colder, and "more scientific." Hippocrates understood that the human is more important than the test. Newman concludes that while modern doctors cringe or shake their heads at Hipprocates quaint diagnostic methods, modern patients "wonder aloud at how nice it might be to have Hipprocrates as their doctor."

All of which leads me to believe that what ails modern medicine just might be what ails modern technological society in general. Even as we are more connected than ever to knowledge and information, we are increasingly disconnected and alienated from each other as human beings.

[Katie · Rating 4 out of 5]

Everyone including doctors should read this book. I learned a lot.

[Joana · Rating 4 out of 5]

Very interesting read for doctors and patients, demystifying some of the ideas hindering patients from getting the best care from their physicians. Exams and treatments that are useless, ailments doctors don't understand, the importance of the placebo effect and, above all, how absolutely essential the relationship between the doctor and the patient is. The sections I most enjoyed were the ones where the author included real examples from his practice. The last quarter of the book dragged on a little, even though I appreciated having the numbers and statistics to look at the data myself, rather than having the author explaining everything to me.

[Joana G F · Rating 2 out of 5]

I enjoyed the start of the book. However, from page 89 onwards it became increasingly tiring and even tedious to read. I feel that this book is more suited to healthcare professionals.
Nevertheless, it was instructive to learn about some of the hidden truths of the medical field.

[Emes · Rating 4 out of 5]

A pleasure to read.

[Marianne · Rating 3 out of 5]

Some of the early chapters were really interesting, but then it really started to drag.

[Julien Rapp · Rating 5 out of 5]

This was an eye-opening book into the world of medicine. The author, Dr. Newman draws on his experience as an ER physician and digs deeper into what works and what doesn’t in modern healthcare. He points out what doctors know, and what they don’t. And why our expectations are so high. He demonstrates how doctors, medical companies (hospitals, pharmaceutical companies, indeed any company in the chain), and more revealing, the consumers - us, all play a role in what has happened to modern healthcare.

For a better look into healthcare today, I also recommend ‘The Healing of America’ by T.R. Reid. These are not books just for Americans, but people around the world.

[Rachel · Rating 5 out of 5]

I give this book five stars based more on the importance of the content rather than the writing and readability. The author exposes flaws in the medical system, as practiced and perpetuated by physicians. As he summarizes it:

“Our knowledge is far more limited than most believe; we advocate and utilize interventions we know don’t work; we disagree on seemingly fundamental issues of science; at system levels we care nothing about communication; we choose technology over touch; we openly defy established evidence; we deny and decry a placebo effect while we tacitly accept and enlist it; and we know precisely how likely each patient is to benefit from an intervention, but seldom tell them.”

He illustrates each of these points with examples that are relevant to many people. Did you know that antibiotics really shouldn't be prescribed for strep throat? That resuscitation is basically useless except in the case of a generally healthy person who keels over out of the blue? That doctors have very different interpretations of EKGs and X-rays--from each other and even from their own previous interpretations? That (my favorite) routine screening mammograms don't save lives and in fact cause more harm than they prevent? There's a lot more too, stuff I found fascinating and significant.

Then, there's the writing. Sentence and paragraph structure is good, paragraphs build logically and eloquently to the points he is trying to make. The chapters build in good progression to the thesis of the book. There's value in looking at each point from different directions, and it's necessary to explain where information comes from and the logic used to interpret it. However, it seemed repetitive; the chapters seemed too long and a bit tedious to read. But just a bit; again, the information is so good that I consider that an excusable minor problem. I would argue on a few minor points; for example, I think a 5-year survival rate for women taking HRT may be meaningless, as many of the problems it causes would surface after a longer period. The author did lose me somewhat in the last chapter; Godel and Heisenberg seem relevant in more a metaphorical than literal way, Maybe some people would like those rather abstruse metaphors more than I.

In any case, nothing detracts from the importance of this book. I see from Amazon reviews that it is being read by many medical professionals and used in some medical school curricula. The author's call for change in thinking and practices has the potential for improvements that would affect us all.

[Jessica · Rating 4 out of 5]

Where alternative and complementary medicine has flourished, it's nearly always a sign of modern allopathic medicine's failure. (15)

Hippocrates cautioned physicians to "make no pretense to infallibility." (15)

... the ancient Greeks made no distinction between 'art' and 'science,' ... Hippocrates and his contemporaries believed the worlds of poetry, music, and medicine to be fundamentally intertwined. (16)

97% of all mammograms positive for breast cancer are false positives. If you get regular mammograms for 10 years, you have a 50% chance of getting a false positive over the course of that decade. (35-36)

As Aldous Huxley once said, "Consistency is contrary to nature, contrary to life. The only completely consistent people are dead." (70)

Antibiotics for strep throat are likely killing far more people than they're saving. (116)

"Most men, when they have already heard one person expounding a subject, refuse to listen to those who discuss it after him, not realizing that it takes the same intelligence to learn what statements ate corrects as to make original discoveries. - Hippocrates (133)

... the experience of the mind deeply affects the human machine to which it is connected. The mind and the body are not separate. (148)

Every condition has its pill. Pills are the great sample of our advanced technology and brilliant science. (156)

This books has a great discussion of NNT or Number Needed to Treat, check out the chart on p. 193 it blew my mind.

[Radhika · Rating 4 out of 5]

I love the content of this book. The message is very important and timely. There are portions of this book that are so clearly and concisely written but I am afraid not all are. Especially when Newman uses the stories of others to make his point, he rambles a bit. One of his greatest strengths lie in taking apart the obfuscations even the best journal articles use to obscure poor to ineffectual findings of medical diagnostic tests or medications. He makes the most mundane statistics come alive when he takes them apart and offers them up again without embellishments. On the other hand by offering italicized stories about specific events he has encountered, he builds the reader's expectation that he is telling us something important and something will be revealed. This tool fails every time and makes the following points always seem a bit anti-climatic. It is this and only this, that has made me give him 4 stars instead of 5. I expect more good stuff to come from David Newman.

This is an important book that consumers of health care in this country should read to arm themselves with more knowledge and to navigate their doctor visits. But I really REALLY wish doctors would read this book and go back to the Hippocratic ideal.

[Kyle Klute · Rating 3 out of 5]

A good reality check on the nature and current condition of medicine in our culture. The author presents 8 reasons why there is a growing unrest and divide between doctors and their patients. The final chapter is worth the price of the book in which he finally gets to what he believes is the fundamental issue at hand in our broken health care system:

"A religious belief in the perfection and power of science has come between us [doctor and patient]. Patients crave science instinctively and physicians defer to it reflexively. Modern culture has devalued the patient doctor bond and medical truth, and encouraged the secrecy and separation needed to maintain this false religion. Physicians and patients are separated from within by a programmed, and shared, mentality. But we can question it and we can deprogram it. Change cannot be mandated, however, only chosen. We must choose to believe that humans are more important than science."

[Carin · Rating 4 out of 5]

Occasionally dry (particularly the last chapter) but overall fascinating look at why patients and doctors both are feeling increasing unsatisfied despite medical advances. Most interesting facts: only 1 in 3 Million people with strep throat treadet with antibiotics will be helped. Even then, antibiotics don't affect strep, they just prevent rheumatic fever. Meanwhile, 2400 of those 3 million people will die from an allergic reaction to the antibiotics, and the rest will have various other side effects and increase their antibiotic resistance. Also 97% of positive mammograms are false. That's a ton of additional stress and unnecessary surgeries. Mammograms do not improve life expectancy at all. Not even by 3% surprisingly.

[Piper · Rating 4 out of 5]

Really is a must read for those who are as averse to the current health system as I am. Heal thy self, has never been more relevant. This doctor talks about the many pitfall of our health care system and admits that there is so much that doctors don't know and can't do much about.
Until we get the pharmaceutical companies to stand down...we will continue to see antibiotics handed out like candy to patients who have no reason to take them. It is time we inform ourselves and advocate for a better way to wellness.

[Sharron · Rating 5 out of 5]

If you've ever ended up in an ER, or even think you might, you need to read this book. If you take any sort of medicine on a regular basis whether for high blood pressure, asthma, cholesterol, migraines, or anything else, you need to read this book. If you have ever taken an antibiotic or some sort of pain medication, you need to read this book. If you have ever had a mammogram or an x-ray, or really any sort of diagnostic test, you need to read this book. Well, you get the idea. You need to read this book.

[Joseph Gowen · Rating 5 out of 5]

Awesome book. I think it should be read by everyone working in the health care field. Why are we so afraid of saying "we don't know," or "I'm sorry"? It should also be read by everyone that ever goes to see a doctor. So we as patients can remember that doctors and tests aren't infallible, and sometimes the body doesn't do what it should.

[David Elpern · Rating 5 out of 5]

This is an important book, written by an ER doc. It explodes many myths we hold about health care. I think it should be read by any sentient person who has an interest in why doctors do the things they do, order screening tests, prescribe some meds, etc. As a physician, my eyes were opened by this book.

[Marina · Rating 3 out of 5]

For those of us in medicine, a must-read. The author is an emergency physician practicing in New York City and is also in the army reserve. Great mix of stories from patients he's seen as a military doctor and civilian doctor. He admits to his arrogance at times, to the uncertainty of medicine, and how medicine is really mostly an art and not hard science as many like to believe.

[Daniel Jafari · Rating 5 out of 5]

a desperately needed reflection on how modern medicine is invoking flase images of its purpose and its power, to maximize income and indexes. the author is one of the nicest people i have met, and his presentation of his work is as fascinating as this book. highly recommended to premed students and public

[April Roggio]

Was a fascinating read, especially for those of us involved in decision making research. Highly recommend - well, perhaps a bit selfishly, as I'd really like to discuss it with someone who's read it...!

[Jennifer · Rating 3 out of 5]

What does your doctor think and why? Read this book. Spoiler alert, doctors do not have all the answers and are merely our guides in discovering the right answers for our unique bodies. INtesting insight for all.

[Will G · Rating 5 out of 5]

Fucking epinephrine! I got lied too! Also there's some other stuff about how Doctors are people and getting crushed by capitalism sucks. Anyway, it's a sweet book if you have a desire to read about statistics and how they are soundly ignored/manipulated.

[Brett Davis · Rating 4 out of 5]

Glad I read it. Thought provoking and flows smoothly and quickly. Uses good science but does not really define each argument fully or from all sides. That would have made the book less enjoyable and smooth so I can see why he didn't address all the critiques of each of his points.

[Jay · Rating 5 out of 5]

A must read. Absolutely essential to anyone suffering from any type of health dysfunction. Dr. Newman spells out the simple truths and myths regarding the health field.

[Tracey]

TCPL Alt title: Hippocrates' shadow : secrets from the house of medicine - Lena Phoenix gave 4 stars

[Jennifer · Rating 5 out of 5]

Really interesting book. Helped me see doctors as real people again. Really improved my relationship with healthcare.

[Margaret · Rating 3 out of 5]

It's like Freakanomics of the US Healthcare system. Other book club members did not like this book, but I found it interesting.

[Andrea · Rating 4 out of 5]

Excellent book for those in the medical field and those not. Talks about where Dr.-patient relationship has gone wrong and how to fix it.