Less Medicine , More Health : 7 Assumptions That Drive Too Much Medical Care

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The author of the highly acclaimed Overdiagnosed describes seven widespread assumptions that encourage excessive, often ineffective, and sometimes harmful medical care. 
 
You might think the biggest problem in medical care is that it costs too much. Or that health insurance is too expensive, too uneven, too complicated—and gives you too many forms to fill out. But the central problem is that too much medical care has too little value.

Dr. H. Gilbert Welch is worried about too much medical care. It’s not to deny that some people get too little medical care, rather that the conventional concern about “too little” needs to be balanced with a concern about “too much”: too many people being made to worry about diseases they don’t have—and are at only average risk to get; too many people being tested and exposed to the harmful effects of the testing process; too many people being subjected to treatments they don’t need—or can’t benefit from. 

The American public has been sold the idea that seeking medical care is one of the most important steps to maintain wellness. Surprisingly, medical care is not, in fact, well correlated with good health. So more medicine does not equal more health; in reality the opposite may be true. 

The general public harbors assumptions about medical care that encourage overuse, assumptions like it’s always better to fix the problem, sooner (or newer) is always better, or it never hurts to get more information. Less Medicine, More Health pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, Dr. Welch notes that while economics and lawyers contribute to the excesses of American medicine, the problem is essentially created when the general public clings to these powerful assumptions about the value of tests and treatments—a number of which are just plain wrong. 

By telling fascinating (and occasionally amusing) stories backed by reliable data, Dr. Welch challenges patients and the health-care establishment to rethink some very fundamental practices. His provocative prescriptions hold the potential to save money and, more important, improve health outcomes for us all. Shop Amazon - Top Rated in Health & Personal Care

Author

Dr. H. Gilbert Welch is an academic physician, a professor at Dartmouth Medical School, and a nationally recognized expert on the effects of medical testing. He has been published in the Los Angeles Times, New York Times, Washington Post, and Wall Street Journal, and has appeared on Today. Dr. Welch is the author of three previous books, including the highly acclaimed Overdiagnosed. He lives in Thetford, Vermont.

SOME OF THE CUSTOMER REVIEWS ABOUT THIS BOOK [ SAMPLE ]

1) Pretty much covers the same ground that the author's previous two books covered - This is the third book in a series of books either authored or co-authored by Welch making the argument that we suffer potentially serious consequences from overdiagnosis and overtreatment. I've now read all three of them. The central points Welch makes in all of them are important ones, for both our personal health and the country's fiscal health: overtreatment is rife, dangerous, and hard to avoid. Welch makes the points persuasively, using the right blend of anecdote and (quasi-) technical explanation. (Think VERY hard before you have that prostate exam, that mammogram, that back surgery, and before you sign on to take statins for slightly elevated cholesterol.) But I don't think that it takes three books to make the argument; there is a lot of repetition and overlap. I would certainly recommend reading ONE of the books, and have in fact made that recommendation to friends, students and colleagues. But I can't recommend buying or reading all three: In my opinion, there simply isn't enough material to justify writing three books on the topic all directed at a popular/non-specialist audience. This third book is the most personal of the three books. But middle book, the co-authored OVERDIAGNOSIS, is the best.

By worddancer VINE VOICE on January 13, 2015

2) Glad I didnt't read this book before my mother's back surgery - I wish I wouldn't have read this book. I say that not because the book was bad, but because it was too good. Some of the chapters just hit a little too close to home. One chapter in particular filled me with fear and another filled me with sorrow.

I started reading the book when my 80 year-old mother went in for major back surgery. I breezed through the first four chapters during her five hours of surgery and two hours in post-op care. The chapters were educational and enlightening. Dr. Welch makes a very compelling case about how we are being over-diagnosed and over-treated. The tone of the book was witty, so I was chucking and nodding my head as I read about data overload, U-shaped curves, the general uselessness of screening, the harm that false alarms can cause, the analogy of types of cancers to barn-yard animals: cancer that will never cause a problem are turtles, cancers that can be fought are rabbits, and cancers you can do nothing about are birds.

Then I got to Chapter 5 and the assumption: Action Is Always Better Than Inaction. First Dr. Welch gave some statistics on hospital infections after surgery: 1.7 Million "health care associated infections" associated with 98,987 deaths in 2002. Whoa doggie, my mom was in surgery. Next he talked about "postoperative cognitive dysfunction" after surgery particularly in the elderly. (Getting scare now - does 80 count as elderly?) Then he talked about needless surgery due to back pain, and how the majority of the time it doesn't work. I wanted to cry at this point, was mom doing this all for nothing? But I felt better when I read the statement: "Back surgery should only be done on patients who don't have back pain". My mom's surgery was to relieve nerve compression caused by severe scoliosis. But then the section on "invasive surgery" had me worried again: her cut was 15 inches long. And the section "Inaction = Allowing the Body to Heal" had me second guessing the decision to have the surgery. Talk about a roller coaster of emotions. I had to stop reading at this point.

I started reading again a few weeks later only to begin Chapter 7 and the assumption: It's all About Avoiding Death. The central theme of the chapter is that sometimes the quality of life is more important than prolonging life by a few months. Particularly with painful, debilitating cancer treatments. This chapter had me sobbing with tears pouring from my eyes. It brought back so many sad memories that are still raw and close to the surface. Three years ago my little brother was diagnosed with colon cancer that had moved to his liver. He fought the "cancer" battle for two years (MD Anderson). He went through all the pain and suffering because he wanted to see his son graduate from high school, he wanted to see his daughter go to her first dance, he wanted to go to the beach one last time. During one treatment (they inserted a tube through his groin and were pumping chemo drugs directly into his liver) he went into cardiac arrest. The doctors brought him back, but later he told me he wished they would have let him die. He said the treatments were too much for his wife, his kids, his family, and him; that sometime the quality of life is more important than quantity. He said it is better to quickly die with dignity than to wither away in excruciating pain. All my brothers' words were being echoed back to me by Dr. Welch.

I'm crying again. Excellent book but like I said I wish I had not read it.

By TooManyHobbies TOP 500 REVIEWER on February 21, 2015