LESS MEDICINE, MORE HEALTH – 7 Assumptions That Drive Too Much Medical Care

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H. Gilbert Welch MD, MPH is professor of Medicine at the Dartmouth Institute for Health Policy & Clinical Practice. His research has focused on the problems created by medicine’s efforts to detect disease early: physicians test too often, treat too aggressively and tell too many people that they are sick. Much of his work has focused on over-diagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer. His first book, SHOULD I BE TESTED FOR CANCER? Maybe not and here’s why (UC Press 2004) was written while he was a Visiting Scientist at the International Agency for Research on Cancer and was one of the six “best books” listed by Malcolm Gladwell in The Week. His second book (with colleagues Drs Schwartz and Woloshin) was OVERDIAGNOSED: Making people sick in the pursuit of health (Beacon Press 2011). He recently published his third book LESS MEDICINE, MORE HEALTH – 7 Assumptions the Drive Too Much Medical Care (Beacon Press 2015).
Abstract from Random House:
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.


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