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CV#752BR: Herbert V. Review of Honest Medicine: Shattering the Myths About Aging and Health Care by Donald J. Murphy, MD. Atlantic Monthly Press, New York, NY 10003. 1995. ISBN 0-87113-587-6, $23.00. N Engl J Med 1996; 334:1275-6. Honest Medicine: Shattering the myths about aging and health care By Donald J. Murphy. 326 pp. New York, Atlantic Monthly Press, 1995. $23. ISBN 0-87113-587-6. Donald J. Murphy's book is a superb, lucid discussion of medical ethics and how patients and doctors can best use the health care system as the individual patient wants it used. Murphy discusses respect for the different points of view of patients and physicians that influence health care decisions (with physicians favoring the public health approach and patients favoring the approach that is best for them individually). He also discusses medical futility, the obligation to attempt resuscitation, and informed consent. He touches on the terrible fact that, faced with the choice between reducing deficits and investing resources to address health problems, our bureaucrats and politicians opt to reduce deficits. Murphy discusses why some patients reasonably want maximal care, others reasonably want no care, and most are reasonably in the middle. He indicates why the doctor should honestly explain all the options to patients and then let them decide what they want or do not want, instead of deciding for them or letting managed-care administrators decide for them. Particularly fascinating are chapter 2, "Numbers behind the Medical `Facts,' " and chapter 3, "Medicine and the Media," which explain why an article in a scientific journal that claims a "relative risk reduction" of 50 percent may mean only a 1 percent reduction of risk for the individual patient ó that is, a 1 percent absolute risk reduction. Murphy eloquently reminds us that the physicianñpatient relationship is a sacred covenant, embodied in the Hippocratic oath, with the physician morally bound to act in the interest of the patient to the exclusion of any self-interest. Such a covenant has recently been endorsed by the American College of Physicians, the American Board of Internal Medicine, and numerous other societies. After reading Honest Medicine, one can only say bravo to such endorsements.
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