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Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care 1st Edition

4.7 out of 5 stars 83 customer reviews
ISBN-13: 978-0807071649
ISBN-10: 0807071641
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Editorial Reviews

Review

“Avoiding medical jargon, Welch speaks directly to the layperson and focuses on certain assumptions that have increased consumption in a market-driven society; some of which have become so ingrained by popular media that refuting them seems downright scandalous… Welch’s words, though wise beyond money, border on sacrilege in a country of generally healthy people who have developed an expensive health-care habit and who are expected to support a lucrative health-care industry. Welch’s conversational style makes his prescription for better health an easy pill to swallow.” 
Booklist, starred review

“A bright, lively discussion of the excesses of medical care to which patients often unwittingly go due to certain false assumptions… Welch demonstrates the flaws in these assumptions. His stories involve the risks, uncertainties and harms of cancer screenings, treatments for heart disease, drugs, medical devices and surgical procedures. He makes an especially strong case for the risks of mass screenings for cancer—the fear, the false alarms, the overdiagnoses and the resulting overtreatments. Vivid images make what could be discouragingly technical quite understandable… Welch's engaging style and touches of humor make this an easy read, and the facts he presents make a convincing case.”
Kirkus Reviews

“Read this book. It is smart, witty, wonderfully written, and above all wise. We've overmedicalized life and yet we need medicine throughout our lives. No one explains better when we do, when we don't, and why.”
—Atul Gawande, author of Complications and Being Mortal

“Wise, witty, fascinating and alarmingly persuasive—this is a book everyone should read, especially my doctor.”
—Bill Bryson, author of A Short History of Nearly Everything

“With the style of a trustworthy country doctor, Welch, an academic heavyweight, urges us to reject the allure of reducing all health risks by using the latest technology to gather all the data and to fix the problems sooner rather than later. Showing the dangers of our ill-informed enthusiasm for medicine, he brilliantly builds the case for respecting its power and limitations: to seek it when ill and all but avoid it when healthy.”
—Victor M. Montori, MD, Professor of Medicine, Mayo Clinic

“Gil Welch's latest book shows us exactly how too much medical care can be harmful and even deadly.  This is a needed corrective to the American attitude that the more screening and testing, the healthier we will be.”
—Marcia Angell, author of The Truth About Drug Companies

“Its title, ‘Less Medicine, More Health,’ sums up his trenchant, point-by-point critique of test-based health care and quality control.”
New York Times

About the Author

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.
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Product Details

  • Hardcover: 240 pages
  • Publisher: Beacon Press; 1 edition (March 3, 2015)
  • Language: English
  • ISBN-10: 0807071641
  • ISBN-13: 978-0807071649
  • Product Dimensions: 6.2 x 0.8 x 9.2 inches
  • Shipping Weight: 1.2 pounds (View shipping rates and policies)
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (83 customer reviews)
  • Amazon Best Sellers Rank: #71,164 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By TooManyHobbies TOP 500 REVIEWER on February 21, 2015
Format: Hardcover Vine Customer Review of Free Product ( What's this? )
I wish I wouldn't have read this book. I say that not because the book was bad, but because it was too good. Some of the chapters just hit a little too close to home. One chapter in particular filled me with fear and another filled me with sorrow.

I started reading the book when my 80 year-old mother went in for major back surgery. I breezed through the first four chapters during her five hours of surgery and two hours in post-op care. The chapters were educational and enlightening. Dr. Welch makes a very compelling case about how we are being over-diagnosed and over-treated. The tone of the book was witty, so I was chucking and nodding my head as I read about data overload, U-shaped curves, the general uselessness of screening, the harm that false alarms can cause, the analogy of types of cancers to barn-yard animals: cancer that will never cause a problem are turtles, cancers that can be fought are rabbits, and cancers you can do nothing about are birds.

Then I got to Chapter 5 and the assumption: Action Is Always Better Than Inaction. First Dr. Welch gave some statistics on hospital infections after surgery: 1.7 Million "health care associated infections" associated with 98,987 deaths in 2002. Whoa doggie, my mom was in surgery. Next he talked about "postoperative cognitive dysfunction" after surgery particularly in the elderly. (Getting scare now - does 80 count as elderly?) Then he talked about needless surgery due to back pain, and how the majority of the time it doesn't work. I wanted to cry at this point, was mom doing this all for nothing? But I felt better when I read the statement: "Back surgery should only be done on patients who don't have back pain". My mom's surgery was to relieve nerve compression caused by severe scoliosis.
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Format: Hardcover Vine Customer Review of Free Product ( What's this? )
This is the third book in a series of books either authored or co-authored by Welch making the argument that we suffer potentially serious consequences from overdiagnosis and overtreatment. I've now read all three of them. The central points Welch makes in all of them are important ones, for both our personal health and the country's fiscal health: overtreatment is rife, dangerous, and hard to avoid. Welch makes the points persuasively, using the right blend of anecdote and (quasi-) technical explanation. (Think VERY hard before you have that prostate exam, that mammogram, that back surgery, and before you sign on to take statins for slightly elevated cholesterol.) But I don't think that it takes three books to make the argument; there is a lot of repetition and overlap. I would certainly recommend reading ONE of the books, and have in fact made that recommendation to friends, students and colleagues. But I can't recommend buying or reading all three: In my opinion, there simply isn't enough material to justify writing three books on the topic all directed at a popular/non-specialist audience. This third book is the most personal of the three books. But middle book, the co-authored OVERDIAGNOSIS, is the best.
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Format: Hardcover Vine Customer Review of Free Product ( What's this? )
As a long-time fan of Gilbert Welch, I was thrilled when this book showed up on my Vine list. I was not disappointed.
It's important to understand that Less Medicine, More Health is much less detailed and technical than Overdiagnosed. I liked the technical info and the statistics but it would be too much for some readers. This book definitely appeals to a broader audience. The tone is lighter as well.

However, Dr. Welch continues to make the point that much of medicine is not related to health. I really liked the way he attacked 7 common myths, such as the myth that more is better. Unfortunately a lot of primary care doctors either don't know or choose to ignore the realities. Dr. Welch gives an example of an educated person who is hounded by Kaiser Permanente because she chose not to have a mammogram. The nurse put on a campaign by phone and email that would be worthy of a used car sales person.

In that case, the woman's doctor seemed to be an outlier in the system. I had an experience with an HMO that was so awful I transferred to a more expensive option to avoid the harassing "reminders" of unnecessary procedures. I've also had the experience of a doctor telling me that certain tests would "add ten years" to my life. Dr. Welch probably would say that's fraud.

I particularly like Dr. Welch's realism about longevity. He points out that he's not likely to die from a heart attack and if he gets cancer, he'll avoid dementia and possibly years of incarceration (my word, not his) in an institution. I fit that profile myself. I'd add that after a certain age, many changes in the numbers signal just old age, not danger - a point he makes in Overdiagnosed - yet doctors insist on treating the numbers.
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Format: Hardcover
Ever since I've turned 50, I've been inundated by mailings from local and regional hospitals (which is kind of creepy - I don't go to a doctor much, so how do they all know my age and address?) with dire warnings about how my "senior" body is a heart attack/stroke/osteoporosis/diabetes just waiting to happen, and I can prevent this disaster only by taking a series of discounted tests offered at ridiculously low prices by the aforementioned medical provider. (These are very similar to the mailings I get from my local car repair service. One time I got them mixed up and accidently took the coupon for a heart scan/bone scan/glucose check in to Mike Anderson Chevrolet to get an oil change/lube job/tire rotation, but that's another story.) I've always been too suspicious to get the medical tests, since I keep thinking they will dig until they find something wrong and then wrack up a series of expensive and gruesome treatments - and after reading Dr. Welch's book, I realized I am correct!
This book is just plain brilliant, and very insightful. Some of my favorite parts are his questioning as to whether it is best to search for problems in asymptomatic people or just leave well enough alone, whether the treatments can sometimes be worse than the conditions treated, and the most profound question - what is the ultimate goal of medical care? Is it to enhance life when necessary, or is it, as with many elderly people, to dominate life and take on a life of it's own, stripping people of all dignity and reducing them to medical projects to the extent that, like many elderly people you see, they are praying for death to release them from the medicalized hell that their lives have become?
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