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

4.31  ·  Rating details ·  516 ratings  ·  91 reviews
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 cent
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Hardcover, 240 pages
Published March 3rd 2015 by Beacon Press
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Bob Clare
Apr 17, 2015 rated it really liked it
As an emergency physician my job mostly involves reassuring people that they DON'T have a serious illness when they're worried that they DO. Many simply aren't satisfied unless I've ordered a lot of "tests." This is not simply my opinion--many studies bear this out as true. Doing less is very difficult when all the incentives point to doing more. I believe over-testing, over-diagnosis, and over-treatment are the real causes behind America's abysmal track record. We spend nearly twice as much per ...more
Elizabeth Theiss
Mar 13, 2015 rated it really liked it
I once had a wonderful physician who used to tell me, "I'll give you my medical-legal opinion and then I'll tell you what I think." She taught me to always ask doctors to think a bit more about their recommendations. If the test is positive, what would we do differently? What are the possible secondary consequences? What happens if we do nothing?

Dr. Welch, a primary care physician, has given us a thoughtful but radical critique of common medical practices, based on epidemiological statistics. In
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Cathy
Jan 18, 2016 rated it it was amazing  ·  review of another edition
Shelves: science, medicine
About a year ago, I found the book "Overdiagnosed: Making People Sick in Pursuit of Health". Upon hearing the audiobook I felt I had finally found an author who shared my opinion on the screening and diagnoses made in health care.

This new book by Welch seems to be directed to the general population. It is less detailed and technical, and the tone is lighter. However, I would recommend it also to all who provide health care.

The author discusses many of the myths that patients and carers have in r
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Sally
Mar 25, 2015 rated it it was amazing
Shelves: health, medicine
I thoroughly enjoyed reading this very sensible discussion about interacting with the healthcare system in such a way that you avoid having your life become unnecessarily medicalized. An once of "prevention," in the form of screenings and tests for the asymptomatic, all too often leads to worse health outcomes rather than better ones. I recommend it. ...more
Carolyn Thomas
Apr 13, 2015 rated it really liked it
This book caught my eye because the title sums up my own philosophy in a nutshell. With eloquence and humour Dr.Welch states the case for his belief that too many people are being made to worry about diseases they don't have and are at only average risk to get, too many people are being tested and exposed to the harmful effects of the testing process, and too many people are being sub jected to treatments they don't need or cannot benefit from.
Below I list the seven assumptions Dr. Welch covers
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George Smith
Jun 30, 2015 rated it it was amazing
As a retired lab tech grunt who toiled away trying to do justice to the tons of specimens submitted for long lists of tests that are ordered by Physicians, I can assure you that more testing is definitely not leading to better care. Welch is a wise physician and I hope his critical view of testing clears the benches of many of those stupid, trivial test requests that we get in the lab. Cut out the cover-your-butt off-the-wall test requests and all of us will benefit-particularly the patient who ...more
Sheela Word
Jul 26, 2015 rated it it was amazing
Practical and convincing information for the layperson about complicated medical issues. Welch, a GP, addresses such question as: (1) Under what conditions is health screening valuable? (2) When is a "risk factor" worth paying attention to? (3) When is medical treatment likely to be helpful and when is it likely to be harmful? Etc.

I checked this book out of the library to read it, but am thinking I should buy it, to have on hand as a sanity check and confidence builder when up against medical au
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James Veliky
Nov 06, 2015 rated it it was amazing  ·  review of another edition
I loved this book. I have been a practicing Optometrist for 41 years and I learned a lot. Dr. Welch wrote this book for the general public but I would recommend it be read by everyone in health care. I am from the little town in western Pennsylvania -Donora - that had the killer smog in 1948 that he references in the book so this resonated a little more with me.
Primarum non nocere-"first do no harm" is the mantra of all in health care. But as Dr. Welch painfully points out," the only Doctor that
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Rana
Mar 12, 2017 rated it it was amazing
Shelves: 2017
The first time I've ever had the statistics used when describing medical probabilities. The power to ignore anything under a 100% increase is a huge gift. ...more
Carol
Jul 18, 2020 rated it really liked it  ·  review of another edition
I’m one of those people who had a screening mammogram that lead to a biopsy, then a mastectomy and then chemo. I had an aggressive cancer (a rabbit in the author’s analogy) and treatment almost certainly saved me. And yet... I have come to believe that there is indeed such a thing as too much testing. And, after reading Atul Gawande’s “Being Mortal,” I have given a lot of thought about what I’d do if my cancer came back - what treatment I’d consent to and what would be a hard no. This book reinf ...more
Sheng Peng
Aug 17, 2019 rated it really liked it
Surprisingly readable and informative book. Read this book lest you be intimidated by the ponderous US healthcare system.
Jeff Brown
Feb 09, 2015 rated it it was amazing
Shelves: 2015, non-fiction
This review was written for LibraryThing Early Reviewers. 4.5 stars.

Lately I have been taking the time to read a few books on health/nutrition every year so that I am better informed about decisions I make for my well being. This book was a worthy first choice for 2015.

The author basically makes the case for less medical intervention for non-acute medical care and end of life situations. I've always thought that nature more or less knows best, and people need to get out of the way of nature when
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Tchipakkan
Jun 15, 2015 rated it really liked it
I just finished Less medicine, more health: 7 Assumptions that Drive Too Much Medical Care , and heartily recommend it!
The seven assumptions are All Risks can be Lowered, It's always better to Fix the problem, Sooner is Always Better, It never hurts to get more Information, Action is always better than inaction, Newer is Always Better, and It's all about Avoiding Death.
Notice those "always" and "never"s? Dr. Welch does recognize that every situation is different and sometimes our new technolog
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Leah
Feb 10, 2015 rated it really liked it
...too much medical care has too little value.

I am not a doctor nor do I work in the healthcare industry. I'm just an ordinary U.S. citizen who happened to wonder about many of the assumptions Welch addresses in Less Medicine, More Health, which is why I requested a copy.

Welch's writing style was conversational and easy to understand. While there were significant amounts of data and stats discussed as well as medical terminology, at no point did I feel like he was talking over my head. He al
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Beth
Feb 01, 2015 rated it it was amazing
I grabbed this book at the ALA Midwinter Meeting because it seemed right up my alley. And I was correct!

About a year ago I read “How We Do Harm,” written by Otis Brawley--the Chief Medical Officer of the American Cancer Society. He was the first perspective I’d read on the potential harms of screening for different types of cancers, and it blew me away. While this book isn’t entirely about screening for cancer, it certainly addresses it, and I feel like everyone should read this important infor
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Anna
Mar 18, 2015 rated it liked it
Shelves: health-nutrition
This book reinforced some basic beliefs of mine - the the more medical care you receive, the worse your health becomes, provided you take care of yourself with proper diet and exercise. In these days of rationing healthcare, self-rationing of medical services is beyond wise. Here are my favorite quotes/summations of the material in the book:

"Medical care can be extremely valuable. But that does not imply it is routinely valuable. Because of the dramatic impact medical care can have on human heal
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Fred Amir
Mar 14, 2021 rated it it was amazing
If you want to avoid being diagnosed with conditions you do not have or treatments you don’t need, then you must read Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care by Dr. H. Gilbert Welch.

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 o
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Elizabeth
May 15, 2015 rated it really liked it
This review has been hidden because it contains spoilers. To view it, click here.
Joan
Mar 01, 2015 rated it it was amazing
I'm glad I read this at this time! I may be needing to make a decision about cochlear implants in the near future and I think this book will help me with the decision. I'm also reminded how I got hounded and nagged into allowing my wisdom teeth to be removed and I really wish I hadn't done so. I was sick for two months after that surgery and there was no good reason to remove them. Welch says only get them removed if there is pain and there wasn't any pain. GRRRRR. It got me into trouble at work ...more
David J Stricklin
Jul 15, 2020 rated it really liked it  ·  review of another edition
I’m a retired Internist and having some professional bond with the author read the book with great interest. I even had the same experience with a 1990 Ford Explorer which is revealed in his book (the excuse given to me was that it was built just as we entered the Gulf War which might have been distracting to workers). While I don’t agree 100% with the book I would highly recommend this book to medical students and others medical providers in training to be medical providers. It provides a persp ...more
Pessick
Oct 12, 2016 rated it really liked it
Interesting book written by Dr. H. Gilbert Welch, a nationally recognized expert on the effects of medical testing, who is an academic physician at Dartmouth Medical School. His premise is that doctors should only do things that stand up to the rigors of quantitative review., for example he feels that many tests given patients are likely to cause unnecessary procedures to be performed, that research as proven are unnecessary and possibly more harmful. He debunks 7 common assumptions about practi ...more
Peacejanz
Dec 17, 2016 rated it it was amazing
Wow! This is a great book for any of us at any age. It is so easy to fall into old assumptions that are not valid. Dr. Welch is a physician on the faculty of Dartmouth Medical School. He counters some ideas that most of us have such as the sooner you are treated, the better. This is not to say that you should ignore physical or emotional problems but you do not always have to rush to get some things "healed." Best of all like a good academic professor, Dr. Welch provides the source of all he ass ...more
Davis Graham
May 09, 2016 rated it it was amazing
The author gives real-life stories of how medicine has gone awry by being driven by the payer driven healthcare system we have in place today. Jonathan Bush points out the eagerness of the dollar over the health of the patient. Robert Morgan in his book about Daniel Boone gives us the realization that we need to return to understanding and accepting the gift of a beautiful death. This book gave some insightful strategies from a physician's point of view as to how our payment system has drifted s ...more
Rita	 Marie
Aug 23, 2015 rated it it was amazing
Shelves: read-nonfiction
Since I agree with all the ideas in this book, and have for many years, of course I thought it was terrific. I particularly appreciated the correct presentation of statistics (yes, correct statistical methodology is one of my soapboxes). Most doctors are sadly ignorant of statistics and use metrics in ways that can be harmful.

So, getting down off the soapbox, other good things are: the book is written in a pleasant, conversational style, it's an easy, fast read, and if you're fussy there is a c
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Nancy
Oct 28, 2018 rated it it was amazing
Ready, Aim, Fire! Consider this a direct hit to the idea that an annual physical along with the side tests of pap smear, mammogram and bone density have any usefulness to our health and well-being. Dr. Welch backs up all of his opinions with research, and more importantly interpretation of that research. I now fully understand that certain headlines that report a 50% reduction in certain risks are misleading. If you want to know what is useful medical testing and which is useless, or even harmfu ...more
Jess Dollar
May 17, 2015 rated it really liked it
Excellent. I highly recommend everyone read this book to better understand the pros and cons of things like cancer screenings.
The book is basically about iatrogenics, harm from the healer, which I learned about first from Nassim Taleb in Antifragile. It's important to understand that going to the doctor is likely to cause more problems than it solves in non-emergency situations. This book lays out some of the reasons why this is so in order to make us better health-care consumers.
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Ann
Welch presents many important topics in a way that is not so intuitive to the average medical consumer, or physician. I recommend his books to friends and family. Key points: always consider the option of doing nothing, there are real risks to screening for disease.
Sandra Ross
Jun 26, 2018 rated it it was amazing
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
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Tyler
Mar 11, 2020 rated it really liked it  ·  review of another edition
Very much worth a read — it may impact your life

This book does a good job articulating why receiving medical care ought to be more of a decision than something to take for granted, and the fact that making this decision is often not nearly as straightforward a decision as we're typically inclined to think. I'd highly recommend reading this book as a way to realign the way you think about medical care in general — it very well may have a legitimate impact on your life, and it's certainly changed
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BethK
Mar 30, 2019 rated it it was amazing
Shelves: nonfiction, medical
A must-read for anyone seeking medical care! Written by a doctor, this book vividly describes the notions that drive people to seek more medical care, more medical testing, and cause more testing to be advertised and recommended. Some of it is not good for us. The numbers often used in advertising and "awareness campaigns" are not relevant to what we should look at. How much will it help, how much will it harm, how big of a problem are we trying to overcome?

None of us are completely "healthy" as
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61 likes · 5 comments
“Two decades ago the federal government invited 150,000 men and women to participate in an experiment of screening for cancer in four organs: prostate, lung, colon, and ovary. The volunteers were less likely to smoke, more likely to exercise, had higher socioeconomic status, and fewer medical problems than members of the general population. Those are the kinds of people who seek preventive intervention. Of course, they are going to do better. Had the study not been randomized, the investigators might have concluded that screening was the best thing since sliced bread. Regardless of which group they were randomly assigned to, the participants had substantially lower death rates than the general population—for all cancers (even those other than prostate, lung, colon, and ovary), for heart disease, and for injury. In other words, the volunteers were healthier than average. With randomization, the study showed that only one of the four screenings (for colon cancer) was beneficial. Without it, the study might have concluded that prostate cancer screening not only lowered the risk of death from prostate cancer but also deaths from leukemia, heart attack, and car accidents (although you would hope someone would raise the biological plausibility criterion here).” 2 likes
“any one of us can draw the bad card of an aggressive cancer. Good people—doing all the right things—still get sick. It’s tempting to want to find something—or someone—to blame.” 1 likes
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