Contents INTRODUCTION Is Health Care Fixable? 1 CHAPTER I A New System: The Irrational Human Mind and the First Few Who Recognized It By Are People Rational or Irrational? « Who Was Right? “Six Sigma” + “Esoteric Gibberish” CHAPTER 2 How Health Care Became a “Culture of Inefficiency” 41 The Perfectionist * The Radical Mastectomy Begins * The Rise of the Clinical Trial « Measuring the Way Forward « The First “Well-Executed” Clinical Trial + Skeptics Emerge + “In God We Trust, All Others [Must] Have Data” Extreme Variation and Extreme Overtreatment * Complexity * “The Whole System Is Cockamamic” A Cowboy Culture + CHAPTER 3 How Simple and Effective Treatments Get Lost 81 “You Should Get Your Affairs in Order” + “Re-establishing the Balance of Nature” + “Pretty Close to Miraculous” * The Low-Hanging Fruit in Health Care + New Uses for Old Drugs » No One Seems to Give a Shit CHAPTER 4 ‘The Way Forward: “From Worst to First” 109 The Billy Beane of Health Care * The Fresh Food FarmacyCHAPTER 5 Nature or Nurture: What Really Matters? “Genes Are Not Our Destiny” » Epigenetics + Social Genomics + Cognitive Traps and the Pursuit of Happiness + A New Culture + The Future of Medicine Acknowledgments Notes Selected Bibliography Index 127 175 177 187 199