LESS MEDICINE, MORE HEALTH

A bright, lively discussion of the excesses of medical care to which patients often unwittingly go due to certain false assumptions.

In a natural follow-up to his previous book, Welch (co-author: Overdiagnosed: Making People Sick in the Pursuit of Health, 2011, etc.), a primary care physician who teaches at Dartmouth Medical School, warns that too much medical care can be bad for your health. Patients and doctors are driven toward action by various forces—e.g., patients feel they are being paid attention to, which makes them feel better, and doctors like getting credit for trying if not for curing. The author lays out his argument around seven faulty assumptions too often made by the public: 1) All risks can be lowered; 2) It’s always better to fix the problem; 3) Sooner is always better; 4) It never hurts to get more information; 5) Action is always better than inaction; 6) Newer is always better; 7) It’s all about avoiding death. Drawing on history, scientific research, statistics and his own experience, 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: Small, nonlethal tumors that need no treatment are “turtles,” aggressive ones that have already spread and are beyond cure are “birds,” and the ones that might be stopped by early treatment are “rabbits.” In Welch’s view, cancer screening can find “rabbits” but it creates the problem of overdiagnosis of “turtles” and offers little benefit to “birds.”

Welch’s engaging style and touches of humor make this an easy read, and the facts he presents make a convincing case.