More Than Medicine: The Broken Promise of American Health

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.)