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

4.27  ·  Rating details ·  357 Ratings  ·  69 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
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
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
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
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
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.
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
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.
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
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 also
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
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
May 15, 2015 rated it really liked it
This review has been hidden because it contains spoilers. To view it, click here.
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
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
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
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
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
Aug 31, 2017 rated it it was amazing
Extremely important book that I wish everyone would read. Welch -- a Dartmouth medical school professor, internist at the VA Medical Center in White River Junction, VT, and a medical researcher -- looks at the beliefs physicians and patients have that lead them to make poor decisions concerning medical care and provides evidence to show why we are mistaken. He makes convincing arguments that risks can't always be lowered and trying to do so creates risks of its own; trying to eliminate a problem ...more
Wendy Churchill
Jan 31, 2018 rated it liked it
I agree with the idea and enjoyed his humour. I felt it belaboured the point a bit. But, no chemotherapy or mammograms for me!
Alexander Tsedrik
Mar 30, 2018 rated it it was amazing
Do not agree with the author on many points, but overall, the book is really good and delivers alternative view on medical interventions
Oct 27, 2017 rated it really liked it
Makes excellent points. Americans would do well to listen to this advice. Especially American doctors.
Susan H
May 30, 2017 rated it it was amazing
I'm really glad I read this. There is a lot of useful information in it for anyone who is wondering why their doctor is insisting on certain tests when there are no symptoms.
Alison Hastings
Jun 07, 2018 rated it really liked it
As a physician I really enjoyed this book. It makes sense and is thought provoking. I’m in agreement. More is not always the answer.
Mar 05, 2017 rated it really liked it
excellent, thought provoking and should be required reading for our over-medicalized culture.
Jul 07, 2017 rated it really liked it
I recommend this book. Even if you don't agree with it all, I think it'll help you worry less about the deluge of medical advice and new findings that the media overwhelms us with constantly.

I've been skeptical about the idea that screening mammograms may be overdone, because my own breast cancer was an invasive 3.5 cm stage 2 tumor when it was found on a screening mammogram. It wasn't palpable even to my doctor a few weeks before that because it was so close to the chest wall in very dense bre
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
Apr 23, 2015 rated it really liked it
Shelves: non-fiction, library
The older I get, the more I question the 'wisdom' of Western medicine, particularly the almost unavoidable 'preventative care' that Americans have shoved down their throats at every opportunity. My husband's employer's recent decision to institute a 'wellness' program that utilizes a carrot and stick approach - participate in these activities we have decided are good for your health (health questionnaires, screenings, annual physicals, exercise programs, etc.) and you'll be rewarded; otherwise, ...more
Bimal Patel
Aug 16, 2015 rated it liked it
Alright, so here's my take on this book. It's well written and easy read. The target reader is most likely a non-medical professional. The author makes valid points about overuse to screenings in medicine and treating abnormalities rather than disease. We think more data about our health is a good think but it's not. We have seen a surge in technologies that promises to give us real time information about our physiology and people are flocking to buy such gadgets but more data is not necessarily ...more
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“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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