HM had intended at the end of the immediately preceding post, “Understanding the Science of Elusive Health Risks” to provide a reference to an earlier healthy memory blog post on medical care. After several exhaustive attempts he was unable to provide this reference. So the current post is one he intended to post but apparently forgot. That’s unfortunate as this is an important post on an important topic. This book is titled “Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care, “ by Dr. Gilbert Welch. The previous post dealt with understanding information on health risks. Welch’s book is more relevant as to how to interact with you physician. This book is an easier read and less technical than the Science of Elusive Health Risks.
As Dr. Welch has a Master of Public Health (MPH) in addition to his MD and has worked as an epidemiologist as well as a primary care physician. As the subtitle indicates, there can be too much medical care that leads to adverse conditions. A good example of this was given in my personal anecdote in the previous post about the Prostate Specific Antigen Test (PSAT). At one point this test was virtually mandatory. Later, it became a test to use only under special circumstances. One might question, what is the harm in testing?
Prostate cancer is something that eventually occurs in all males. However, many males will likely die of something else before they die from prostate cancer. And the treatments for prostate can be uncomfortable and some can lead to incontinence and impotence. There are discomfort and risks to most cancer treatments. And cancer screening does reveal false positives, that is a mistaken result, as well as failures to detect. Then there is the speed of the cancer. If it is very slow it is possible that the person will outlive the cancer and die from something else. All the studies on the benefits of cancer screening are based on survival rates of people who tested positive. But HM has yet to see a comparison of the death rates between people who were not screened versus people who were screened. If screening did beneficially impact the overall death rate, the result would be compelling indeed. Should anyone know of such a study, please reply.
I am going to copy the table of contents as it provides the basic guidance being offered. HM strongly recommends reading the entire book. Should you question any of the assumptions, then it is imperative for you to read the book.
“ASSUMPTION #1: ALL RISKS CAN BE LOWERED
Disturbing truth: Risks can’t always be lowered—and trying creates risks of its own.
ASSUMPTION #2: IT’S ALWAYS BETTER TO FIX THE PROBLEM
Disturbing truth: Trying to eliminate a problem can be more dangerous than managing one.
ASSUMPTION #3: SOONER IS ALWAYS BETTER
Disturbing truth: Early diagnosis can needlessly turn people into patients
ASSUMPTION #4: IT NEVER HURTS TO GET MORE INFORMATION
Disturbing truth: Data overload can scare patients and distract your doctor from what’s important.
ASSUMPTION #5: ACTION IS ALWAYS BETTER THAN INACTION
Disturbing truth: Action is not reliably the “right” choice.
ASSUMPTION # 6: NEWER IS ALWAYS BETTER
Disturbing truth: New interventions are typically not well tested and often wind up being judged ineffective (even harmful).
ASSUMPTION #7: IT’S ALL ABOUT AVOIDING DEATH
Disturbing truth: A fixation on preventing death diminishes life.
CONCLUSION: Seeking medical care is not the most important thing you can do for your health.
Although these assumption sound reasonable, perhaps even eminently reasonable, Dr Welch effectively debunks them. Should you doubt this, read the book.
Dr. Welch personalizes his advice by writing what he does under various conditions.
Unfortunately the medical system in the United States is primarily one of fee for service. So the incentive is to treat and the financial incentive is to provide costlier treatments.
It is a shame that this book was not on the best seller list. Perhaps it’s not too late.
Some individuals prefer to place themselves in the hands of their doctors. This is a matter of personal choice. However, the practice of medicine is done by humans, and we all are fallible. And there is ample evidence of the failures of medicine. So it is your option to ask questions, conduct research, and make your own decisions.
© Douglas Griffith and healthymemory.wordpress.com, 2016. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.