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.

A lively, accessible, and fully illustrated guide to the history of medicine, from ancient practices to cutting edge innovations. Clifford Pickover continues his popular series that includes The Physics Book and The Math Book with this volume chronicling the advancement of medicine in 250 entertaining, illustrated landmark events. Touching on such diverse subspecialties as genetics, pharmacology, neurology, sexology, and immunology, Pickover intersperses “obvious” historical milestones—the Hippocratic Oath, general anesthesia, the Human Genome Project—with unexpected and intriguing topics like “truth serum,” the use of cocaine in eye surgery, and face transplants.

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.

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 trailblazing, conversation-starting history of women’s health—from the earliest medical ideas about women’s illnesses to hormones and autoimmune diseases—brought together in a fascinating sweeping narrative. Elinor Cleghorn became an unwell woman ten years ago. She was diagnosed with an autoimmune disease after a long period of being told her symptoms were anything from psychosomatic to a possible pregnancy. As Elinor learned to live with her unpredictable disease she turned to history for answers, and found an enraging legacy of suffering, mystification, and misdiagnosis. In Unwell Women, Elinor Cleghorn traces the almost unbelievable history of how medicine has failed women by treating their bodies as alien and other, often to perilous effect. The result is an authoritative and groundbreaking exploration of the relationship between women and medical practice, from the "wandering womb" of Ancient Greece to the rise of witch trials across Europe, and from the dawn of hysteria as a catchall for difficult-to-diagnose disorders to the first forays into autoimmunity and the shifting understanding of hormones, menstruation, menopause, and conditions like endometriosis. Packed with character studies and case histories of women who have suffered, challenged, and rewritten medical orthodoxy—and the men who controlled their fate—this is a revolutionary examination of the relationship between women, illness, and medicine. With these case histories, Elinor pays homage to the women who suffered so strides could be made, and shows how being unwell has become normalized in society and culture, where women have long been distrusted as reliable narrators of their own bodies and pain. But the time for real change is long overdue: answers reside in the body, in the testimonies of unwell women—and their lives depend on medicine learning to listen.

The essential guide by one of America's leading doctors to how digital technology enables all of us to take charge of our health A trip to the doctor is almost a guarantee of misery. You'll make an appointment months in advance. You'll probably wait for several hours until you hear "the doctor will see you now"-but only for fifteen minutes! Then you'll wait even longer for lab tests, the results of which you'll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical. In The Patient Will See You Now, Eric Topol, one of the nation's top physicians, shows why medicine does not have to be that way. Instead, you could use your smartphone to get rapid test results from one drop of blood, monitor your vital signs both day and night, and use an artificially intelligent algorithm to receive a diagnosis without having to see a doctor, all at a small fraction of the cost imposed by our modern healthcare system. The change is powered by what Topol calls medicine's "Gutenberg moment." Much as the printing press took learning out of the hands of a priestly class, the mobile internet is doing the same for medicine, giving us unprecedented control over our healthcare. With smartphones in hand, we are no longer beholden to an impersonal and paternalistic system in which "doctor knows best." Medicine has been digitized, Topol argues; now it will be democratized. Computers will replace physicians for many diagnostic tasks, citizen science will give rise to citizen medicine, and enormous data sets will give us new means to attack conditions that have long been incurable. Massive, open, online medicine, where diagnostics are done by Facebook-like comparisons of medical profiles, will enable real-time, real-world research on massive populations. There's no doubt the path forward will be complicated: the medical establishment will resist these changes, and digitized medicine inevitably raises serious issues surrounding privacy. Nevertheless, the result-better, cheaper, and more human health care-will be worth it. Provocative and engrossing, The Patient Will See You Now is essential reading for anyone who thinks they deserve better health care. That is, for all of us.