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H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (Boston: Beacon Press, 2015), 218pp.H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (Boston: Beacon Press, 2015), 218pp.

H. Gilbert Welch, an academic epidemiologist at Dartmouth Medical School, is a leading expert on what might be called minimalist medicine. It's a subject that he's written about in two previous books — Should I Be Tested for Cancer? Maybe Not and Here's Why (2006) and Overdiagnosed: Making People Sick in the Pursuit of Health (2012). American health care has many problems, but in Welch's view "the central problem is that too much medical care has too little value." Over-medicalization is not only wasteful, in many cases it's harmful. We've overstated the benefits of medicine and ignored its dangers.

Welch doesn't blame his fellow doctors, the insurance companies, policy makers, or even the malpractice lawyers. He's more interested in our underlying cultural assumptions that drive patients and their families to believe, wrongly, that more medicine is always better. His book challenges seven of these assumptions, and offers in their stead seven "disturbing truths." For example, not all risks are equal, not all risks can be lowered, and trying to do so can sometimes even increase medical risks. Or again, there's a big difference between managing and fixing a problem, raw data versus useful information, newer versus better, doing everything possible and trying nothing at all.

Welch writes with wit, wisdom, and self-effacing candor. At heart he's a statistician, so for him the truth-telling of randomized trials is the gold standard. He acknowledges that his subject matter is deeply personal and contingent upon personal values. He draws upon his considerable clinical experiences to tell good stories. He also writes about his own medical choices about tests, scans and screenings, and why he made those choices. In the end, Welch proposes a radical alternative to conventional wisdom — we should not equate more medicine with better health. I enjoyed this book so much that I recommended it to my primary care physician.

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