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 central problem is that too much medical care has too little value. Dr. H. Gilbert Welch is worried about too much medical care. It's not to 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. So more medicine does not equal more health; in reality the opposite may be true. The general public harbors assumptions about medical care that encourage overuse, assumptions like it's always better to fix the problem, sooner (or newer) is always better, or it never hurts to get more information. Less Medicine, More Health pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, Dr. Welch 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 medicalASSUMPTION #1: ALL RISKS CAN BE LOWEREDDisturbing truth: Risks can't always be lowered-and trying creates risks of its ownASSUMPTION #2: IT'S ALWAYS BETTER TO FIX THE PROBLEMDisturbing truth: Trying to eliminate a problemcan be more dangerous than managing oneASSUMPTION #3: SOONER IS ALWAYS BETTERDisturbing truth: Early diagnosis can needlessly turn people into patientsASSUMPTION #4: IT NEVER HURTS TO GET MORE INFORMATIONDisturbing truth: Data overload can scare patients and distract your doctor from what's importantASSUMPTION #5: ACTION IS ALWAYS BETTER THAN INACTIONDisturbing truth: Action is not reliably the "right" choiceASSUMPTION #6: NEWER IS ALWAYS BETTERDisturbing truth: New interventions are typically not well tested and oft en wind up being judgedineffective (even harmful)ASSUMPTION #7: IT'S ALL ABOUT AVOIDING DEATHDisturbing truth: A fixation on preventing death diminishes lifeCONCLUSION: Seeking medical care is not the most important thing you can do for your healthAcknowledgmentsNotesIndex
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