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Unlike most books about medical tourism which do not critique why there should be a need for Americans to travel to foreign lands for important, needed medical care, Katz discusses at length how her health insurance coverage is so terrible that she is essentially forced to go abroad for her surgery as a last resort. As a non-wealthy person in the real world, Katz has had enough personal experiences and watched enough friends suffer to understand that the healthcare system in the United States is all about making a profit, not necessarily healing patients or keeping them healthy. As a result, she refuses to refer to her health insurer as the ���insurance company,��� but only as her ���Withholding Company.��� ���Hey, there���s nothing wrong with making money...My issue is with the immorality of a for-profit system that squeezes the life out of people in need. There must be a more decent way to make a billion...How do these guys sleep at night?��� writes Katz. She doesn���t explicitly say that the United States should pass a single-payer system like Medicare, but she implies that a national health insurance system would be preferable to the ���hell��� that people like her currently endure when seeking medical care. After carefully studying her policy and thoroughly researching the costs, Katz concludes that she and her husband would need to pay at least $90,000 out of pocket to get her hips replaced and that the only workable solution would be to get the surgeries in India. So she does, through a company that arranges all the details of these sorts of trips. The rest of the book is all about her (successful) surgery experience in India and her slow recovery to full mobility back in the United States. As can be expected from a memoir, Katz���s personal observations can come across at times as incredibly na��ve. For example, Katz describes Indian doctors and the Indian healthcare system as infinitely more warm, attentive, and human, and implies that, unlike in the United States, their system is not motivated by money. Umm, you are an American who was able to scrape together $19,000 cash���about 38 times the average annual household income in India���and you think that the quality and manner of care you are receiving in India is not heavily influenced by money? Please. And she, more than once, referred to persons or things there as ���exotic.��� But, overall, Katz���s tale is an interesting one of the lengths a patient must go to in order to circumvent our sorry excuse for a healthcare system. ���Lucia Hwang 20 N AT I O N A L N U R S E How We Do Harm: A Doctor Breaks Ranks About Being Sick in America By Otis Webb Brawley, M.D., with Paul Goldberg; St. Martins Press, 2012 Y ou���d be forgiven for being suspicious of Dr. Otis Brawley upon opening How We Do Harm: A Doctor Breaks Ranks About Being Sick in America. He starts out with his bona fides: He���s a physician. He���s a biostatistician. He���s an epidemiologist. You might just think he���s full of himself. But soon, you���d discover in this book, cowritten with investigative journalist Paul Goldberg, that he���s actually full of righteous fury about the inequities in our healthcare system. The book, in fact, is a call for no less than a social movement for sane and science-based healthcare for all. Healthcare reform hasn���t worked from the top down, he argues. What we need is a groundswell inside and outside medicine. ���Genuine healthcare reform���like the right to vote���will not be granted magnanimously,��� he writes. ���Like civil rights, the right to good health care will have to be won in public struggle. To bring about real change, real people will have to say, ���Enough!������ How we get to ���Enough!��� is laid out thoughtfully in the following 250 pages. Brawley promises a ���guided tour of the back rooms of American medicine,��� and he delivers with story after story of what Brawley thinks is wrong with America���s healthcare system. As a statistician, he values individual stories less than research, so he starts with the most damning numbers: While our healthcare system is the most expensive in the world (costing $8,000 per person a year and amounting to 18 percent of our gross domestic product), we come in 50th worldwide in health outcomes. Then he lays out the particulars, wedding statistics with often enraging and heartbreaking stories of real patients he���s treated: ���wallet biopsies��� that determine how much care a patient gets; the more-is-better ethos that encourages researchers to put patients��� health in danger to overload them with treatment, doctors to do extreme treatments and patients to ask for more care even when to do so would harm a terminally ill loved one; corrupt doctors and hospitals that all but sell patients for parts, giving them so much care that every practitioner who gets involved gets a cut; so-called evidence-based medicine guidelines driven by profit motive rather than scientific reality; health screenings as money makers; poverty as a carcinogen; and finally, an American culture that valorizes new treatments and technology even when it can harm them, even when it can overrun their lifetime maximums and cost them their health insurance coverage, even when it could shorten their lifespans. In short, and without saying so explicitly, Brawley has found what many of us know already: Capitalism in healthcare makes for a sick system. ���I have seen enough to conclude that no incident of failure in American medicine should be dismissed as an aberration,��� he states plainly. ���Failure is the system.��� Along the way, we are treated to a little background on Braw- W W W. N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T 2 0 1 2