Nortin M. Hadler, MD, MACP, MACR, FACOEM
Emeritus Professor of Medicine and Microbiology/Immunology | UNC at Chapel Hill
Chapel Hill, NC, US
For 35 years Dr. Hadler has been a student of “the illness of work incapacity." Over 200 papers and 12 books bear witness to this interest.
Dr. Hadler trained at the Massachusetts General Hospital, the NIH, and the Clinical Research Centre in London. He was certified a Diplomate of the American Boards of Internal Medicine, Rheumatology, Allergy & Immunology, and Geriatrics. He joined the faculty of the University of North Carolina in 1973, was promoted to Professor in 1985 and transitioned to Emeritus Professor of Medicine and Microbiology/Immunology in 2015. He served as Attending Rheumatologist at the UNC Hospitals till 2015. In recognition of his clinical activities, he was elevated to Mastership in both the American College of Physicians and the American College of Rheumatology.
The molecular biology of hyaluran and the immunobiology of peptidoglycans were the focus of his early investigative career. Because of the contributions of his laboratory, he was selected as an Established Investigator of the American Heart Association and elected to membership in the American Society for Clinical Investigation. The focus on basic biology was superseded by “industrial rheumatology.” Over 200 papers and 12 books bear witness to his analyses of “the illness of work Incapacity” including the sociopolitical constraints imposed by various nations faced with the challenges of applying disability and compensation insurance schemes to predicaments such as back pain and arm pain in the workplace as well as for a more global illness narrative such as is labeled “fibromyalgia.” Occupational Musculoskeletal Disorders (3e), published by LWW in 2005, sets forth his thinking on the regional musculoskeletal disorders. In recognition of this work he was elected to the National Academy of Social Insurance and is a Fellow of the American College of Occupational and Environmental Medicine.
Fifteen years ago he turned his critical razor to much that is considered contemporary medicine at its finest. Assaults on medicalization and overtreatment have appeared in many editorials and commentaries, and in 6 monographs. In 2015 he assumed a leadership role in an initiative designed to provide rational health care as an evidence-based, cost effective, employer-sponsored, defined contribution, insurance benefit.
Industry Expertise (3)
Areas of Expertise (8)
Harvard Medical School: M.D., Medicine 1968
Yale University: A.B., Undergraduate Studies 1964
Media Appearances (5)
Can Big Data Make Better Healthcare Cheaper?
To The Point (KCRW in Los Angeles) radio
Medical records are being digitized on a massive scale to bring down the costs of healthcare and, maybe, to produce better outcomes. It also means a loss of patient privacy. We weigh the risks and the benefits of Big Data in the field of medicine. Also, JP Morgan may face criminal action in the Madoff case, and the nations of Africa race to compete — in space.
KOJO NNADMDI WAMU radio
Pharmacology’s exploded in the two decades, but for all the pills we pop, why is the greatest predictor of life expectancy NOT our genetics or behavior, but our individual socio-economic status? The answer’s not as simple as you think. We meet a physician and medical educator who’s trying to help all Americans ask better questions of our doctors, and figure out whether our medical routines are helping us improve our quality of life.
Nortin Hadler rheumatologist; author "Worried Sick: A Prescription for Health in an Overtreated America" (UNC Press) and Professor of Medicine, UNC School of Medicine
The People's Pharmacy radio
High cholesterol is well known as a risk factor for heart disease. But far too many people are under the impression that taking a medication to lower cholesterol also reduces their risk of dying from an initial heart attack. While all our experts agree that statin-type drugs such as Crestor, Lipitor and Zocor (simvastatin) are appropriate for a person who has established heart disease, they disagree about the benefits for preventing heart disease in healthy people. Learn how the benefits and risks stack up for people like you.
How A Sugar Pill Can Treat Mental Illness
The State of Things (WUNC) radio
Pharmaceutical companies spend billions developing the next big drug. But sometimes, all a patient needs is a sugar pill. The placebo effect is a well-documented phenomenon where the belief that a treatment is helping can actually cause symptoms to subside, even if the treatment is imaginary.
Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill, said on The State of Things that we have known about placebos for a long time, starting with a man named Henry Beecher.
The Prostate Test
On Point with Tom Ashbrook radio
Huge studies came out last week on the number-one cancer issue in men’s health. Women wrestle with breast cancer. Men: prostate.
It’s generally slow-growing. It can show up even among twenty-year-olds. And it can be an obsession for men over 50.
But how aggressive should we be in screening and treating? In cutting it out? The upside: it may save your life. The downside risk: incontinence and impotence, and expensive intervention that may not have been necessary.
This hour, On Point: The latest on prostate cancer, and whether the treatment is worse than the disease.
You can join the conversation. Have you been diagnosed with prostate cancer? Have you gone for the full treatment? Or hung back? What do you make of the new studies?
Journal of Rheumatology
In this issue of The Journal Mary-Ann Fitzcharles and colleagues present statistics describing the appeals process for patients with “fibromyalgia” (FM) whose indemnity claim for workers’ compensation had been denied by the Workplace Safety and Insurance Board (WSIB) of Ontario, Canada1. No doubt these descriptive statistics will be of interest to and even have use for those involved in this process in Ontario. They may even be relevant to actuaries and policy-makers in other jurisdictions. But are they of interest to anyone else? In particular, are they of interest to rheumatologists who are not involved in the workers’ compensation indemnity scheme of Ontario?
I will argue the affirmative; this process is a window on the social construction of illness and on the role of the physician in determination of disability. I have a personal bias in that this fascination has captured a great deal of my scholarly efforts for many decades. A recent monograph bears witness and hopefully can imbue the reader with a similar level of interest2.
Journal of Occupational and Environmental Medicine
Employer-sponsored health insurance covers 157 million Americans.1 Most large employers provide their employees with choice among several plans designed to meet individual needs based on factors such as age, health status, and level of desired insulation against catastrophic loss. Almost all the plans expect employees to share the cost through an array of fees, ranging from the monthly payroll deduction to out-of-pocket fees for doctors' office visits and medications. And although notions of copay, coinsurance, and deductible are inculcated in the training of an actuary or benefits manager, they are less familiar to most employees trying to make the appropriate trade-offs when choosing a health plan. Each employee has to weigh his or her particular personal and financial circumstance with the best approximation of the value a particular coverage might have for that employee or employee's family going forward. Moreover, classic studies in the behavioral sciences have shown that when individuals trade off multiple options that vary on numerous features, they often resort to simplistic strategies that fail to pay off in the long run 2—in the case of health insurance, a strategy that would lead to choosing an overly expensive plan.
The current study was designed to probe the values different employees bring to the choice between employer-sponsored plans with different elements of health coverage. Such knowledge is important both from the perspective of the employer or insurance company offering the plans and from the perspective of the employees who must choose among those plans.
Journal of Occupational and Environmental Medicine
The inherent tension between concerns for sick people and concerns for sick peoples has occupied generations in the pantheon of philosophers.1 This tension is reshaping the communitarian ethic yet again. The welfare state is undergoing rapid transformation to an “enabling state” wherein “social welfare policies are increasingly being designed to enable more people to work and to enable the private sector to expand its sphere of activity 2.” To my way of thinking, valuing human capital goes beyond productivity and meritocracy; it is a philosophy of life that tolerates some lapses, empathizes with vicissitudes and countenances failure. To my way of thinking, an enabling state without altruism will be short-lived. The institution of medicine that serves an enabling state must answer this calling. This essay outlines one approach.
The Journal of the American Medical Association
In 1911, New York was the first state to legislate “workmen's compensation insurance.” By 1949, all states independently administered workers' compensation insurance programs. Several stipulations were common to these statutes and remain so today. Foremost is to indemnify medical costs and lost wages when a worker has experienced a work-related personal injury, generally defined as an injury that arose “out of and in the course of employment.”1 The intent of these schemes is to minimize the financial toll that compounds such injuries. From the outset, the notion of “injury” was contentious. For instance, if an inguinal hernia is first noticed at work, is that a compensable injury? It became so when “rupture” became parlance.
This essay argues that however well it serves its adherents, the fibromyalgia construct poses dangers for patients so labeled and for those likely to suffer that fate. The contagion of the concept reflects the medicalization of psychosocial problems for which biomedicine has few solutions. We propose an alternative social construction for persistent widespread pain that makes it acceptable for patients to seek solutions in modulating the predisposing psychosocial hazards rather than persist in the belief that the solution must reside in neurobiology. We propose that a public examination of the social construction is ultimately more likely to prove palliative than any exercise in medicalization.