A nationally recognized expert describes seven widespread assumptions that encourage excessive, often ineffective, and sometimes harmful medical care—for fans of Overdiagnosed and Malcolm Gladwell

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. He doesn’t 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. More medicine does not equal more health; in reality the opposite may be true.

In Less Medicine, More Health, Dr. Welch pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, he 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.

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 on Today. Dr. Welch is the author of three previous books, including the highly acclaimed Overdiagnosed. He lives in Thetford, Vermont.

INTRODUCTION: Our enthusiasm for everything medical

ASSUMPTION #1: ALL RISKS CAN BE LOWERED
Disturbing truth: Risks can’t always be lowered—and trying creates risks of its own

ASSUMPTION #2: IT’S ALWAYS BETTER TO FIX THE PROBLEM
Disturbing truth: Trying to eliminate a problemcan be more dangerous than managing one

ASSUMPTION #3: SOONER IS ALWAYS BETTER
Disturbing truth: Early diagnosis can needlessly turn people into patients

ASSUMPTION #4: IT NEVER HURTS TO GET MORE INFORMATION
Disturbing truth: Data overload can scare patients and distract your doctor from what’s important

ASSUMPTION #5: ACTION IS ALWAYS BETTER THAN INACTION
Disturbing truth: Action is not reliably the “right” choice

ASSUMPTION #6: NEWER IS ALWAYS BETTER
Disturbing truth: New interventions are typically not well tested and oft en wind up being judged
ineffective (even harmful)

ASSUMPTION #7: IT’S ALL ABOUT AVOIDING DEATH
Disturbing truth: A fixation on preventing death diminishes life

CONCLUSION: Seeking medical care is not the most important thing you can do for your health

Acknowledgments
Notes
Index