Too Much Medicine?

One doctor’s prescription for today’s health care

Often excessive, ineffective and sometimes harmful — that’s Dr. H. Gilbert Welch’s view of today’s medical care. The doctor certainly has the credentials to make that assessment, and have it taken seriously. He is an academic physician, a professor at the prestigious Dartmouth Medical School and a nationally recognized expert on the effects of medical testing.

Welch challenges (surely to the chagrin of many doctors and the health-care industry) the common belief that more is better when it comes to medicine. He says, “As a society, we have overstated the benefits of medical care and understated its harms. And that is just possible that less medicine is better for our health.”

In his recently released book, “Less Medicine, More Health” [Beacon Press, $24.95], he examines seven health-care assumptions: all risks must be lowered, it’s always better to fix the problem, sooner is always better, it never hurts to get more information, action is always better than inaction, newer is always better and it’s all about avoiding death.

Perhaps the most thought-provoking — the last on the list. He counsels that death isn’t always a bad thing. He uses his parents as an example: His father died of cancer at 60 and his mother died in her late 80s after years of dementia. He asks, which is worse? His advice is “strive to live, not to avoid death.”

He also explains how to knowledgeably assess risk, when it’s better to manage a problem rather than trying to eliminate it, how scanning and early diagnosis can needlessly turn people into patients, the importance of distinguishing between lots of data and useful knowledge and why tried-and-true interventions are often better than newer ones that haven’t been fully tested.

For the health-obsessed, Welch’s prescription could be unsettling; for others, it could be freeing.

Either way, it’s a dose of reality that needs to be considered.