He was further prompted to write the book, he explains, by the healthcare reform bill debates, because absent from the discussion was the imperative to "empower patients to make informed decisions, just like we do for consumers for other goods and services."
With an insider's perspective, Makary paints a picture of a secret society, zealously unwilling to be transparent and whose members are unaccountable to anyone but themselves, and certainly not their peers, regulators, payers, or their patients.
The breadth of the issue is such that many hospitals have started to ask their own employees whether they would dare undergo treatment in their own units, and whether their organization's doctors and nurses "do what's in the best interests of their patients," he says.
At about half of the hospitals where at least 70% of the employees participated in the survey, fewer than half answered yes. Scary.
"I am often bewildered at the ethics of a corporation that is aware of a dangerous product, yet continues to sell it," he writes in the book.
While most of Makary's book focuses on perverse incentives in healthcare, and how they influence quality. But, good things are happening in isolated pockets.
He writes that groups are developing quality metrics that rate how hospitals perform, often with real-time data, but the industry needs to figure out how to best use the information for consumers and providers to see how they're doing.