Less Medicine, More Health Quotes

“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).”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“It’s important to acknowledge the role of chance in health.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“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.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“No matter how many determinants of health we throw in the mix, we will never be able to perfectly predict who will experience good health.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“But multiple studies have shown what is labeled overweight (BMI between 25 and 30) is actually associated with lower death rate than what is labeled normal weight (BMI between 18.5 and 25).”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The World Health Organization, for example, currently lists ten determinants of health: income and social status, education, physical environment, employment and working conditions, social support networks, culture, genetics, personal behavior and coping skills, health services, and gender.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“health. In 2011, they came up with this: the ability to adapt and self manage in the face of social, physical, and emotional challenges”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“In 1947, the World Health Organization formulated a definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Embrace life. And don’t dwell on death—recognize that it’s part of life.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“My judgment is this: arthroscopic surgery of the knee has been grossly overused in the United States. Ditto for back surgery. These surgeries shouldn’t be banned; they should be moderated. We are in the midst of a course correction—recognizing that the benefit of arthroscopic surgery is primarily for acute knee injuries, not chronic knee pain, and that the benefit of back surgery is limited to highly selected patients.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“One explanation is intellectual inertia: when we commit to one school of thought, it takes time to move to another. But it also takes time to do the research that overturns the prevailing mindset.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Avoiding death isn’t my top priority anyway; I’d rather avoid a lingering cognitive decline in a long-term”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The first question to ask is obvious: Is there good evidence of benefit? Good evidence means a randomized trial showing lower cancer mortality, not observations crediting turtles with higher survival rates. Frequently, the honest answer will be no. If so, I’d stop there. If benefit hasn’t been proven, I wouldn’t pursue the test—because harms are always part of the deal.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“You should understand that the only doctor that never has a role in causing harm is the doctor who no longer sees patients.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Patient stories of “success” are very powerful, but they can also be very misleading. Few want to raise the alternative possibility: the patient didn’t need the intervention in the first place—they were going to be fine without intervention, perhaps they would be even better. No one, particularly doctors, has any interest in raising the possibility that they went through all that for nothing.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Now I’m having a heart attack. My baseline risk has just skyrocketed: now we’re talking about a 7 percent versus 9 percent risk of dying in the next thirty days. Unless death has become a desirable outcome for me—and at some point it likely will—I’ll take the 7 percent, thanks.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“PRESCRIPTION: FOCUS ON REDUCING BIG RISKS—FOR THOSE WHO ARE AVERAGE OR BELOW, LEAVE WELL ENOUGH ALONE”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“It is clearly not good to have very high blood sugar. It is clearly good to lower high blood sugar to normal through a combination of diet and exercise. But it clearly is not good to try to medicate diabetic patients until they have a normal blood sugar, because in doing so we will almost certainly cause some patients’ blood sugar to get too low.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“back surgery doesn’t work that well for back pain.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Disturbing truth: Early diagnosis can needlessly turn people into patients”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“What is most certain about screening mammography in the United States is that it leads to a lot of false alarms: worrisome mammograms, and yet subsequent testing—another mammogram, an ultrasound, an MRI, and/or a biopsy—ultimately finds no cancer. For example, among 1,000 American women age fifty screened annually for a decade, how many will have at least one false alarm? Somewhere between 490 and 670. And 70 to 100 will be biopsied to prove they don’t have cancer.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Some of it is simply luck.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Patients with very high blood pressure, for example, stand to benefit a lot more from treatment than do patients with blood pressures slightly above average.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care