Most of us want and expect medicine's miracles to extend our lives. In today's aging society, however, the line between life-giving therapies and too much treatment is hard to see-it's being obscured by a perfect storm created by the pharmaceutical and biomedical industries, along with insurance companies. In Ordinary Medicine Sharon R. Kaufman investigates what drives that storm's "more is better" approach to medicine: a nearly invisible chain of social, economic, and bureaucratic forces that has made once-extraordinary treatments seem ordinary, necessary, and desirable. Since 2002 Kaufman has listened to hundreds of older patients, their physicians and family members express their hopes, fears, and reasoning as they faced the line between enough and too much intervention. Their stories anchor Ordinary Medicine. Today's medicine, Kaufman contends, shapes nearly every American's experience of growing older, and ultimately medicine is undermining its own ability to function as a social good. Kaufman's careful mapping of the sources of our health care dilemmas should make it far easier to rethink and renew medicine's goals.

Acknowledgments ix Introduction. Diagnosing Twenty-First-Century Health Care 1 Part I: The Quandry and Unexamined Ordinariness of Twenty-First-Century Medicine 1. Ordinary Medicine in Our Aging Society: The Dilemma of Longevity 21 Part II. The Chain of Health Care Drivers  2. The Medical-Industrial Complex I: Evidence-Based Medicine, the Biomedical Economy, and the Ascendance of Clinical Trials 53 3. The Medical-Industrial Complex II: Access, Industry, and the Clincial Trials Phenomenon 79 4. "Reimbursement Is Critical for Everything": Medicare and the Ethics of Managing Life 99 Part III: Medicine's Changing Means and Ends 5. Standard and Necessary Treatments: The Changing Means and Ends of Technology 127 6. Family Matters: Kidneys and New Forms of Care 165 7. Influencing the Character of the Future: Prognosis, Risk, and Time Left 195 8. For Whose Benefit? Our Shared Quandary 217 Conclusion. Toward a New Social Contract? 238 Notes on the Research 249 Notes 255 Bibliography 285 Index  307