I give this book five stars based more on the importance of the content rather than the writing and readability. The author exposes flaws in the medical system, as practiced and perpetuated by physicians. As he summarizes it:
"Our knowledge is far more limited than most believe; we advocate and utilize interventions we know don't work; we disagree on seemingly fundamental issues of science; at system levels we care nothing about communication; we choose technology over touch; we openly defy established evidence; we deny and decry a placebo effect while we tacitly accept and enlist it; and we know precisely how likely each patient is to benefit from an intervention, but seldom tell them."
He illustrates each of these points with examples that are relevant to many people. Did you know that antibiotics really shouldn't be prescribed for strep throat That resuscitation is basically useless except in the case of a generally healthy person who keels over out of the blue That doctors have very different interpretations of EKGs and X-rays--from each other and even from their own previous interpretations That (my favorite) routine screening mammograms don't save lives and in fact cause more harm than they prevent There's a lot more too, stuff I found fascinating and significant.
Then, there's the writing. Sentence and paragraph structure is good, paragraphs build logically and eloquently to the points he is trying to make. The chapters build in good progression to the thesis of the book. There's value in looking at each point from different directions, and it's necessary to explain where information comes from and the logic used to interpret it. However, it seemed repetitive; the chapters seemed too long and a bit tedious to read. But just a bit; again, the information is so good that I consider that an excusable minor problem. I would argue on a few minor points; for example, I think a 5-year survival rate for women taking HRT may be meaningless, as many of the problems it causes would surface after a longer period. The author did lose me somewhat in the last chapter; Godel and Heisenberg seem relevant in more a metaphorical than literal way, Maybe some people would like those rather abstruse metaphors more than I.
In any case, nothing detracts from the importance of this book. I see from Amazon reviews that it is being read by many medical professionals and used in some medical school curricula. The author's call for change in thinking and practices has the potential for improvements that would affect us all.