Med­i­cine used to be different. Doc­tors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.

Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas any­more.

After witnessing our “health­care reform” process you must have seen that almost every­thing about med­i­cine is now big business. If you don’t know that by now, you’re not paying attention.

Yes there are still some “little guys” out there, but they’re playing by big business’ rules. What does that mean for you? Hang on, I’m coming to that.

Now it’s often said ” the first rule of business is to stay in business.” It’s not wrong either.

Mary-Kate Olsen expressed it well when she said, “Our ultimate goal is to stay in business. We are not here with a specific plan,” when talking about her company. So Mary-Kate and Ashley Olsen are trying to stay in business by selling you things. No problem. No one expects the Olsens to be looking out for your interests in running their firm. I hope they do well.

But most par­tic­i­pants in the medical industry is also trying to stay in business by selling you things. Big problem. Traditionally we have relied upon our medical care providers to have our best interests at heart. Maybe once they did, but this is not how “business” works. And make no mistake it’s a business. The rules have changed. We need to “be careful out there.”

So, what is the medical industry trying to sell you? Medical care of course — procedures, tests, devices, drugs and treatments. But it’s medical care you may not need or want. It’s even medical care that may be harmful to you. Maybe you think this is hyper­bole or exaggeration. “It’s really not that bad,” you say to your­self. Yes it is. Believe it. It’s been estimated that about 30% of all care is harmful or unnecessary. Per­son­ally I think it’s more than that.

Check it out for your­self. Here are two approaches:

• First, spend an hour or so on the inter­net searching one of the following terms: “overuse,” “harmful,” or “unnecessary” combined with one of these terms: “chemotherapy,” “radiation therapy,” “CT scans,” “hormones,” “spinal surgery,” and “new drugs.” Be prepared to be concerned. And this will just scratch the surface of things being pushed on Amer­i­cans by medical firms of all types (including doc­tors) desperate to stay in business.

• Second, find a freethinking doc­tor or hospital administrator — one who’s been around a while. If you have one who is a personal friend that’s even better. Get him or her alone for a private conversation with an adult beverage or two and ask, “How much is med­i­cine in America influenced by big business?” and “What do you see happening that makes money for some­one in the system but doesn’t make too much sense for patients?” Trust me, you won’t like what you hear.

The medical industry has also largely sold us on the idea that health and wellness comes from them. It works like this — sell the idea that care is necessary for health and wellness, then sell as much care as possible.

Of course it’s wrong. Health and wellness is largely an inside job. How you live is likely to be the most important determinate of your own personal health and wellness.

So what’s the answer? We’re not going back to Kansas, and we’ve got to deal with reality. Let’s be educated consumers of care. Let’s take charge of our health­care and our bodies. Care for your­self physically, emotionally and spiritually.

Take a skeptical attitude towards more testing and more treatment. Don’t be an “easy sale” for the medical industry that over-promises and under delivers.

Peter J. Weiss is an internal medicine physician and former health plan CEO.  He is author of More Health Less Care and can be reached at More Health, Less Care: Building America’s Wellness System.

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