Book and media reviews.

WALTER BORTZ HAS LIVED A REMARKABLE LIFE. HE VOLUNteered with Mother Teresa in Calcutta, who advised him to “just love the dying.” He discussed the origin of life with Freeman Dyson at the starting line of the Boston Marathon. He invited Norman Cousins to join him in a panel discussion on wellness, and Linus Pauling sat in the first row. Bortz is a senior geriatrician, an octogenarian marathon runner, and a proud dad. He is also an inquisitive thinker, reaching into history, philosophy, anthropology, and astrophysics to diagnose what is wrong with medicine today and to suggest alternatives. Next Medicine is his description of how medicine has gone off the tracks and what should be done to recover the grand ambitions of Bortz’s beloved profession. It is also a fascinating memoir. Next Medicine begins with the diagnosis. The author states that medicine today is showing severe symptoms, including excessive cost, injustice, harmfulness, corruption, inefficiency, and irrelevance. The symptoms he describes are the antithesis of the Institute of Medicine’s definition of quality: safe, timely, effective, efficient, equitable, and patientcentered. He then traces the history of Western medicine, beginning with inferences from Neanderthal bones and Egyptian mummies before moving rapidly through Greek and Roman medicine into the Middle Ages and then on to modern allopathic medicine. Bortz often refers to seminal essays that have shaped views of health and summarizes important studies of health and wellness, including some of his own research. Next Medicine features an excellent review of the literature showing the health benefits of exercise. Bortz’s pithy anecdotes and quotes remind readers that through the end of the 19th century, medicine had little genuine help to offer patients. Bortz, however, had a front-row seat as medicine entered the modern era. His father was the president of the American Medical Association in 1947, when it vigorously opposed government-funded universal health care. Bortz’s career spans remarkable advances in antibiotics, cancer therapy, cardiovascular therapy, and surgery, but he notes that better hygiene and nutrition have added more productive years to humans’ lives than blockbuster medications and expensive medical devices. Still, he is happy that he was able to undergo knee arthroscopy, which helped him return to running. Bortz regrets that the deeply personal medicine of his younger days has given way to a medical-industrial complex, in which super-specialization and corporate profits are more important than increasing social welfare. Next Medicine is peppered with examples in which opportunities to improve health are lost for lack of profitability. He is distressed that bariatric surgery is preferred over increased exercise and new pharmaceutical agents over diabetes prevention. Bortz argues strenuously for increased personal accountability and has developed an algebraic formula to show that more than half of lost life expectancy is attributable to behavior, as individuals continue to consume too many calories and not exercise enough. He does acknowledge that random events afflict even those fully invested in maintaining their own health and argues that a call for more personal responsibility does not mean assigning blame. Many of his assertions seem to apply better to populations than to individuals. Some of the author’s political projections seem wishful at best. He predicts that a governmental board, analogous to the Federal Reserve, to regulate health care will “come to pass as political pressures demand a revolution,” and he believes that the future direction of US health care will be informed by the study of health systems in Europe and elsewhere. He is adamantly opposed to for-profit and feefor-service medicine, and he prescribes a single-payer quasi-governmental system insulated from political pressures. Bortz’s life has been infused with intellectual curiosity, an abiding care for his patients, and a keen sense of social justice. With Next Medicine, he turns his attention from patients to the US health care system. This text is a clear manifesto for better attention to public health and reorientation of the medical system toward prevention. It is to be hoped that Bortz will continue to plumb his knowledge, wisdom, and experience to drive improvements of the badly broken US health care system. However, whereas his target is reform of the system, the real changes necessary extend far beyond the medical profession.