Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care by H. Gilbert Welch
My rating: 5 of 5 stars
The author of this book is an doctor who is practiced for years as a PCP and now teaches at Dartmouth. One of his areas of expertise is what the data (and these are extensive research studies) about the results of medical screening show and how the screening causes more harm than good.
Three areas where he provides irrefutable proof of the greater harm of medical screening are in screening for breast cancer, prostate cancer, and cervical cancer. One of the interesting facts that he brings out is that these tests are not looking for everything to be okay, but instead they are looking for something to be wrong. He then shows what happens if something looks wrong – may not be – and the harm done from the followup procedures, surgical or otherwise.
Cancer, it turns out, is something we all have somewhere in our body. It is not necessarily a malignant growth or something that is likely to to spread for most people. We live with it, we die with it, but we don’t die from it. Dr. Welch has some really interesting studies to back this up.
However, two things drive this medical screening overkill – and most medical professionals don’t even realize this, because these “wellness checks” are so ubiquitous in the field – and one of those is money, of course, because insurance pays for procedures, while it is reluctant and sometimes won’t pay for consultant medicine that focuses on “eat better, exercise, and lose some weight” kind of health advice. The other thing is Big Pharma. They’d rather you take a pill, which insurance will also pay for, than to fix your lifestyle.
The subtitle of this book is “The Seven Assumptions That Drive Too Much Medical Care.” They are (and Dr. Welch disproves each of these):
1. All risks can be lowered (they can’t).
2. It’s always better to fix the problem (the side effects of prostate cancer surgery to fix the problem are definitely not better than the problem).
3. Sooner is always better (it’s not, because rushing into something that may not be a problem long-term creates a long-term, and sometimes, rest-of-your-life problem).
4. It never hurts to get more information (much of the testing that gets done is in pursuit of this, but the majority of it doesn’t yield any more understanding, and sometimes information overload can make you and your PCP go off the rails in chasing possible solutions).
5. Action is always better than inaction (it’s not, because sometimes if you just leave well enough alone, it will resolve itself).
6. Newer is always better (this is what Big Pharma banks on and this is what newer medical procedures bank on, and while some of the newer medical procedures are better than the older ones, in many cases, newer simply never bears the fruit of better).
7. It’s all about avoiding death (this is the engine of modern health care, and it ignores the fact that we’re all going to die, whether it’s today, tomorrow, next week, next year, or years from now, so you may be delaying the inevitable, but you’re sacrificing quality of life for quantity of life, and that is never a good thing).
I would like to encourage everyone to read this book. It is very illuminating. As someone who grew up in a medical family where our general philosophy was if you’re dying – or think you are – you might give some thought to seeking medical help. Anything less than that would take care of itself eventually, and you would certainly never go see a doctor if there’s not anything wrong.
Modern health care has turned this upside down with “wellness programs” that encourage non-sick people to go to a doctor, go through the wringer to see if they can find anything wrong or that might be wrong, and then go through hell physically and financially to, most likely, find out that there’s nothing to be concerned about (and, of course, I’m not referring to the small percentage of people who do have life-threatening illnesses and they choose to seek treatment for it).