Less Medicine More Health

A nationally recognized expert describes seven widespread assumptions that encourage excessive, ineffective, and sometimes harmful medical care—for readers of Overdiagnosed and Malcolm Gladwell 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. He doesn’t 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. More medicine does not equal more health; in reality the opposite may be true. In Less Medicine, More Health, Dr. Welch pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, he 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.

An exposé on Big Pharma and the American healthcare system’s zeal for excessive medical testing, from a nationally recognized expert More screening doesn’t lead to better health—but can turn healthy people into patients. Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on 25 years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with “abnormal” test results have been drastically lowered just when technological advances have allowed us to see more and more “abnormalities,” many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10% of 2,000 healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with “pre-disease” or for being at “high risk” of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

American science produces the best medical treatments in the world. Yet U.S. citizens lag behind in life expectancy and quality of life. Robert Kaplan marshals extensive data to make the case that U.S. health care priorities are sorely misplaced—invested in attacking disease, not in solving social problems that engender disease in the first place.

What if your cell phone could detect cancer cells circulating in your blood or warn you of an imminent heart attack? Mobile wireless digital devices, including smartphones and tablets with seemingly limitless functionality, have brought about radical changes in our lives, providing hyper-connectivity to social networks and cloud computing. But the digital world has hardly pierced the medical cocoon. Until now. Beyond reading email and surfing the Web, we will soon be checking our vital signs on our phone. We can already continuously monitor our heart rhythm, blood glucose levels, and brain waves while we sleep. Miniature ultrasound imaging devices are replacing the icon of medicine--the stethoscope. DNA sequencing, Facebook, and the Watson supercomputer have already saved lives. For the first time we can capture all the relevant data from each individual to enable precision therapy, prevent major side effects of medications, and ultimately to prevent many diseases from ever occurring. And yet many of these digital medical innovations lie unused because of the medical community's profound resistance to change. In The Creative Destruction of Medicine, Eric Topol--one of the nation's top physicians and a leading voice on the digital revolution in medicine--argues that radical innovation and a true democratization of medical care are within reach, but only if we consumers demand it. We can force medicine to undergo its biggest shakeup in history. This book shows us the stakes--and how to win them.

Written by a groundbreaking figure of modern medical study, Tracking Medicine is an eye-opening introduction to the science of health care delivery, as well as a powerful argument for its relevance in shaping the future of our country. An indispensable resource for those involved in public health and health policy, this book uses Dr. Wennberg's pioneering research to provide a framework for understanding the health care crisis; and outlines a roadmap for real change in the future. It is also a useful tool for anyone interested in understanding and forming their own opinion on the current debate.

"The division between conventional and traditional medicine is as artificial as the division between science and nature. They can be woven together in a fashion that meets our physical, emotional, and spiritual needs. This is the foundation upon which integrative medicine is built." -- Tieraona Low Dog, M.D. In Life Is Your Best Medicine, Dr. Low Dog weaves together the wisdom of traditional medicine and the knowledge of modern-day medicine into an elegant message of health and self-affirmation for women of every age. This is a book that can be read cover to cover but also dipped into for inspiration or insight about a particular physical or mental health issue or remedy. We learn that, despite the widespread availability of pharmaceutical medications, advanced surgical care, and state-of-the-art medical technology, chronic illness now affects more than 50% of the American population. The evidence is overwhelmingly clear that much of the chronic disease we are confronting in the United States has its roots in the way we live our lives. Research shows that if Americans embraced a healthier lifestyle, which includes a balance between rest and exercise; wholesome nutrition; healthy weight; positive social interactions; stress management; not smoking; limited alcohol use; and no or limited exposure to toxic chemicals; then 93% of diabetes, 81% of heart attacks, 50% of strokes, and 36% of all cancers could be prevented! This means that each one of us has the power to shift the odds of being healthy in our favor. And if you do get sick, being fit gives you a much better chance for getting well. Your health has a great deal more to do with your lifestyle and a lot less to do with taking prescription drugs than most people realize. Part I. The Medicine of My Life is a personal and passionate introduction to the book Part II. Honoring the Body includes Food, Supplements, Illness, Wholeness Part III. Awakening the Senses includes Nature, Garden, Music Part IV. Listening to Spirit includes Humor, Relationships, Play, Meditation, Animals Epilogue. Contentment

How data from our health-related Internet searches can lead to discoveries about diseases and symptoms and help patients deal with diagnoses. Most of us have gone online to search for information about health. What are the symptoms of a migraine? How effective is this drug? Where can I find more resources for cancer patients? Could I have an STD? Am I fat? A Pew survey reports more than 80 percent of American Internet users have logged on to ask questions like these. But what if the digital traces left by our searches could show doctors and medical researchers something new and interesting? What if the data generated by our searches could reveal information about health that would be difficult to gather in other ways? In this book, Elad Yom-Tov argues that Internet data could change the way medical research is done, supplementing traditional tools to provide insights not otherwise available. He describes how studies of Internet searches have, among other things, already helped researchers track to side effects of prescription drugs, to understand the information needs of cancer patients and their families, and to recognize some of the causes of anorexia. Yom-Tov shows that the information collected can benefit humanity without sacrificing individual privacy. He explains why people go to the Internet with health questions; for one thing, it seems to be a safe place to ask anonymously about such matters as obesity, sex, and pregnancy. He describes in detrimental effects of “pro-anorexia” online content; tells how computer scientists can scour search engine data to improve public health by, for example, identifying risk factors for disease and centers of contagion; and tells how analyses of how people deal with upsetting diagnoses help doctors to treat patients and patients to understand their conditions.

A renowned diagnostician shares stories of his patients and explores the importance of the human factor in medicine. In The Art of Medicine, Toronto Western Hospital’s internist Dr. Herbert Ho Ping Kong draws on his vast dossier of personal cases and five decades as a clinician to examine the core principles of a patient-centered approach to diagnosis and treatment. While HPK, as he is fondly known, recognizes and applauds the many invaluable innovations in medical technology, he makes the point that as disease and its management grow increasingly complex, physicians must learn to develop an arsenal of more basic skills, actively using the arts of seeing, hearing, palpation, empathy, and advocacy to provide a more humane and holistic form of care. Aimed at medical practitioners, aspiring doctors, or anyone interested in health and medicine, this book also contains interviews with more than a dozen of HPK’s patients, as well as short essays that explore the thinking of his professional colleagues on the art of medicine.