Why managing your health means less medicine, not more

'Less Medicine, More Health'
'Less Medicine, More Health' by Dr. H. Gilbert Welch
Book cover courtesy of publisher

In his new book "Less Medicine, More Health", Dr. H. Gilbert Welch argues that Americans seek out tests, treatments, and attention from doctors and "too many people are being tested and exposed to the harmful effects of the testing process."

From a review on the JAMA Internal Medicine Blog:

(Welch) gallantly takes on medications, imaging, devices, surgeries, and screening. He even, as a lifelong primary care physician, questions the value of the "annual physical." There are no sacred cows to Welch. And that is good for the rest of us, who are happy to pull up a chair and sit beside him as he smoothly walks us through the sometimes seemingly paradoxical truth that has emerged over decades of research. His conversational style is disarmingly effective, so that while he displays an authoritative grasp on the evidence, he slowly pulls you over to his side, wrapping his arm around you like he is letting you in on some of the secrets of the world that only come with hard-earned wisdom.

Welch joined MPR News' Kerri Miller to talk about his research.

Interview highlights

Welch explains the latest theory of treating cancer: the barnyard pen.

It's not always clear if preventative screening is helpful or harmful to patients.

"One of the things for people to really try to understand is that screening is not a free lunch," he said. "It comes with some human costs. I'm not just talking about dollar costs and those human costs are the problems with false alarms, the extra procedures and the problem of over diagnosis."

It's not just about cutting costs.

Even if you have all the money in the world, it's important to decide how much we want to be "medicalized while we are well," he said.

Most screening tests don't save lives.

From Welch's New York Times opinion piece:

The basic strategy behind early diagnosis is to encourage the well to get examined -- to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn't find any evidence for this in its recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly -- into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms).

Sometimes doing less is better.

Welch and Miller discussed a recent MPR News interview with Ezekiel J. Emanuel, oncologist and a vice provost at the University of Pennsylvania.

It's time to rethink the purpose of the annual exam.

"Instead of a head-to-toe effort to try to find things wrong, it's more a chance to connect with your physician, have a conversation so he or she knows who you are," Welch said.

Angelina Jolie is a special case and it's not because she's rich, beautiful or married to Brad Pitt.

"She has the BRCA-1 mutation and—really importantly—she has a really strong family history: her mother, her grandmother and her great-grandmother all had ovarian cancer," Welch said. "That's a person who is at a 35-times higher risk than average for dying from ovarian cancer. The average American woman would face a lifetime risk of 1.3 percent of even developing ovarian cancer."

If you have a complicated medical situation, bring someone with you.

It's important to have another set of ears and an additional person in the room to stand up for your wishes, he said.

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