“Our Parents, Ourselves”“Our Parents, Ourselves”

To the Editor: In his review of my book “Our Parents, Ourselves: How American Health Care Imperils Middle Age and Beyond,” Dr Fillit¹ describes it as factual and well researched but lacking impartial discussion. My viewpoint certainly conflicts with the implications of his review that our health care system is fine, the pharmaceutical industry benevolent, and old age evermore golden.

A majority of Americans receive, on average, only 40% to 50% of standard care.² Managed care has disrupted patient-physician relationships as people shuffle between insurance plans. The rising number of Americans unable to afford any insurance reflects a particular threat for middle-aged persons.³ Individuals may wait hours in an emergency department already overwhelmed by other uninsured and insured patients. Unemployed middle-aged persons do not easily find jobs that include health insurance; individual coverage may either be unaffordable or unobtainable owing to preexisting conditions.

Fillit criticizes inadequate mention of pharmaceutical contributions to the “longevity revolution” and to medical education. My book clearly acknowledges the importance of medications —one reason for concern with their excessive expense. However, aggressive and sometimes deceptive pharmaceutical marketing to consumers and physicians and industry-sponsored medical education encourage inappropriate prescribing.⁴ “Polypharmacy” among older Americans may cause symptoms commonly attributed to “old age” and often entails a mix of overtreatment and undertreatment.⁵ Drug manufacturers fail to report harmful—even lethal—adverse effects.⁶

Fillit would prefer if my book had focused on baby boomers' healthy aging rather than on frailty, chronic disease, and long-term care. He ignores my emphasis on ways today's middle-aged persons might avoid problems they see among their parents' generation, including recommendations from his Institute for the Study of Aging.⁷ However, while increased longevity may bring delayed and perhaps lessened frailty and impairment, it will not eliminate them. He does not mention my description of improved geriatric training and care models, or of the need for expanded in-home services. He correctly reports my support for single-payer national health insurance, including nonprivatized Medicare, yet never addresses arguments underlying my position.