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Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care, by Dr. H Gilbert Welch
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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 25 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.
- Sales Rank: #1471451 in Books
- Published on: 2016-05-24
- Released on: 2016-05-24
- Formats: Audiobook, MP3 Audio, Unabridged
- Original language: English
- Number of items: 1
- Dimensions: 6.75" h x .50" w x 5.25" l,
- Running time: 8 Hours
- Binding: MP3 CD
Review
“Avoiding medical jargon, Welch speaks directly to the layperson and focuses on certain assumptions that have increased consumption in a market-driven society; some of which have become so ingrained by popular media that refuting them seems downright scandalous… Welch’s words, though wise beyond money, border on sacrilege in a country of generally healthy people who have developed an expensive health-care habit and who are expected to support a lucrative health-care industry. Welch’s conversational style makes his prescription for better health an easy pill to swallow.”
—Booklist, starred review
“A bright, lively discussion of the excesses of medical care to which patients often unwittingly go due to certain false assumptions… Welch demonstrates the flaws in these assumptions. His stories involve the risks, uncertainties and harms of cancer screenings, treatments for heart disease, drugs, medical devices and surgical procedures. He makes an especially strong case for the risks of mass screenings for cancer—the fear, the false alarms, the overdiagnoses and the resulting overtreatments. Vivid images make what could be discouragingly technical quite understandable… Welch's engaging style and touches of humor make this an easy read, and the facts he presents make a convincing case.”
—Kirkus Reviews
“Read this book. It is smart, witty, wonderfully written, and above all wise. We've overmedicalized life and yet we need medicine throughout our lives. No one explains better when we do, when we don't, and why.”
—Atul Gawande, author of Complications and Being Mortal
“Wise, witty, fascinating and alarmingly persuasive—this is a book everyone should read, especially my doctor.”
—Bill Bryson, author of A Short History of Nearly Everything
“With the style of a trustworthy country doctor, Welch, an academic heavyweight, urges us to reject the allure of reducing all health risks by using the latest technology to gather all the data and to fix the problems sooner rather than later. Showing the dangers of our ill-informed enthusiasm for medicine, he brilliantly builds the case for respecting its power and limitations: to seek it when ill and all but avoid it when healthy.”
—Victor M. Montori, MD, Professor of Medicine, Mayo Clinic
“Gil Welch's latest book shows us exactly how too much medical care can be harmful and even deadly. This is a needed corrective to the American attitude that the more screening and testing, the healthier we will be.”
—Marcia Angell, author of The Truth About Drug Companies
“Its title, ‘Less Medicine, More Health,’ sums up his trenchant, point-by-point critique of test-based health care and quality control.”
—New York Times
About the Author
H. Gilbert Welch, M.D., M.P.H., is Professor in the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School and Codirector of the VA Outcomes Group in the Department of Veterans Affairs, White River Junction, Vermont.
Most helpful customer reviews
65 of 67 people found the following review helpful.
Glad I didnt't read this book before my mother's back surgery
By TooManyHobbies
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.
5 of 5 people found the following review helpful.
Read it before it is too late
By Samil Korkmaz
This book was especially relevant to me because my mother (65 years old) underwent a colonoscopy in which the doctor removed a few polyps and one of them had cancer cells close to the colon wall. Three out of four doctors said that she must have an operation which would remove a quarter of her colon (without saying anything about the risks of the operation). Only one doctor pointed out that may be all the cancer cells were taken out during the polyp removal, the risks and probability of success of the operation (which were horrible numbers). In the end my mother reasoned that the operation was not worth it. This was 6 months ago. Today she is alive and well, tending her garden.
Almost everybody has some sort of abnormality that won't hurt him but becomes a problem due to early diagnosis, i.e. you would be better of if did not perform the checks in the first place. Lesson: Don't do full checkups, only deal with things that you have symptoms of.
It shows the importance of randomization and biases that can be overlooked when performing medical trials, for example a trial based on volunteers can be biased because health conscious individuals are healthier than the average.
0 of 0 people found the following review helpful.
A wise doctor's prescripton for a happy, healthy, unmedicalized life
By Nancy Robertson
If I were president, the very first thing I would do is appoint Dr. Welch as US Surgeon General so he could slay the test pushing, pill popping, money grubbing healthcare monster. Today we are ordered to take tests we don't need for diseases we don't have and subjected to treatments that won't benefit us while we watch our wallets bled dry.
Unfortunately, I can't appoint Dr. Welch as Surgeon General, but I can recommend Less Medicine, More Health, a book that will teach you how to take control of your own healthcare so you can achieve the best health with a minimum of medical intrusion. Reading this book is like sitting down with a well respected, caring and wise physician, which is exactly what Dr. Welch is -- a professor of medicine and public health at Dartmouth Medical School, a doctor who was actually trained by the previous Surgeon General, Dr. C. Everett Koop.
I read Dr. Welch's previous book Overdiagnosis, and I have to say that while I loved the first book (and gave it a glowing review on amazon), the second book is even better because it doesn't just tell which medical tests to avoid, it tells you how to approach each interaction with doctors and the healthcare system, regardless of whether you are perfectly healthy, acutely ill, chronically ill, or dying. Moreover, it does it in an easy to read and enjoyable, conversational style.
I'm in my mid 60s and have given a lot of thought to how I want to live out the rest of my days. I'm happy to say it's exactly how Dr. Welch wants to live out the rest of his days. Like Dr. Welch, I want to stay as healthy as possible for as long as possible, but without medicalizing my life. That means I eat right, exercise, get vaccinations and treat only those conditions I actually have. I don't subject myself to anxiety provoking screenings to find new problems unless I have actual symptoms. I value my present happiness and ability to lead a pleasant, unmedicalized life far more than I do the small probability of extending my life by extraordinary means just so I can live long enough to develop another horrible illness. I want to enjoy a healthy, happy life today, but I absolutely refuse to making avoiding death my primary goal.
Thank you, Dr. Welch, for writing this important book and for spreading the message that we can safeguard our health by living right and seeking medical care only when necessary. We can take control and avoid being victims of the wasteful, harmful, greedy healthcare monster.
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