DEADLY CHOICES:
Coping with Health Risks in Everyday Life

by Jeffrey E. Harris MD PhD

Published by Basic Books/Harpercollins
Hard Cover Edition, 1993; Paperback, 1995.
ISBN-0-465-02889-6

[Book Cover]


JAMA: The Journal of the American Medical Association
August 17, 1994, Vol 272, No. 7

Deadly Choices: Coping With Health Risks In Everyday Life, by Jeffrey E. Harris, 269 pp, $21, ISBN 0-465-02889-6, New York, NY, BasicBooks Inc, 1993.

The appetite of the American public for medical information is insatiable. The need is met by an unremitting torrent that fills our airwaves, television screens, bookshelves, and supermarket checkout stands. The content is matched to every taste and educational level. Sensational stories of miracle cures, sex changes, and monstrosities fill the tabloids. Sexual aberrations and dysfunctional behavior are the staples of daytime television. Bookstore shelves groan with the weight of treatises on nutrition, victimization, and self-esteem. No end of advice is available to the afflicted on how to overcome a variety of chronic illnesses. On a slow news day, a physician can always be located to assert that the moon is made of green cheese.

At a more sophisticated level, newspapers, magazines, and television news broadcasts are filled with reports of new research discoveries emanating from press conferences, papers presented at scientific meetings, or summaries of articles from selected medical journals. A variety of expert panels convened by government agencies or private bodies regularly issue "guidelines" on actions that should be taken to maintain good health.

What are the consequences of this onslaught? I doubt that much harm is done. Claims of mysterious toxins and miraculous cures have existed throughout history. Unorthodox treatments will always be marketable. There are several main effects that I see. First, unrealistic expectations of what medicine can accomplish: the parents of my patients look on me with disbelief when I attempt to explain that I do not possess the tools to alter the course of their child's viral illness. "How is it possible," I hear them saying, "that in an era of heart transplants and recombinant DNA therapy you cannot control our child's cough to keep us from being woken up at night?" Who can blame them? Virtually every hospital, medical school, and research center in America pumps out a flood of press releases aimed at furthering medicine's omniscience. Another effect is the search for fault. Agent Orange, Love Canal, and electromagnetic beams have replaced divine will or the whims of fate as etiologic agents. The "take charge of your health" religion mandates that the victims of serious illnesses like cancer obsess on what they did wrong. Guilt is piled on top of pain.

Into this maelstrom of conflicting health information comes a book filled with uncommon good sense. Jeffrey Harris, a Boston internist who is also trained as an economist, wrote Deadly Choices to "help the consuming public to decode the messages from the scientific establishment, the media, and the public health officials." The focus is on how individuals can make practical decisions about their health from information gained from population-based epidemiologic studies. Harris uses an effective format to convey this information. Real-life characters are invented to wrestle with six "deadly choices": having unprotected sex, going on a diet, embarking on an exercise regimen, quitting smoking, cutting down on cholesterol, and undergoing breast cancer surgery.

Harris eschews absolute answers. The frailties of the advice put forth by expert panels are exposed. Over and over he illustrates the concepts of relative risk and controlled trials. Unfortunately, he is not likely to be invited to tout his book on the shows of Oprah, Sally Jessy, or Phil. That is a pity. Individuals do not have to agree with the conclusions of orthodox science, but they should be familiar with the elements of scientific reasoning. My only quibble is that parts of the book are hard to digest. Some of the physiological information, such as how the body mass index or maximal oxygen consumption is derived, is provided in needless detail.

Deadly Choices is an ideal primer for laypersons faced with vexing medical issues who have a desire to delve into how scientifically oriented physicians think.

Abraham B. Bergman, MD

Harborview Medical Center

Seattle, Wash