Sharon R. Kaufman examines the quandary of patients, families and doctors not knowing the point where enough medical treatment becomes too much treatment. A hidden chain of drivers among science, industry, new technology, and insurance spur this quandary, serving to obscure the ability to identify the difference between extraordinary and ordinary medicine.

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