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Book Review by Robin Widmar

“Less Medicine More Health”

Today, we face a tidal wave of medical advice: Get an annual checkup, mammogram, colonoscopy, have your cholesterol and glucose levels checked; and be sure to monitor your blood pressure throughout the year. Should anything be amiss ó fear not! There is a drug or medical procedure for you.But one man has been on a crusade for years. Dr. H. Gilbert Welch believes this routine testing is filled with pitfalls that may actually do more harm than good. In addition, he warns, while the latest and greatest drugs produce a resounding ka-ching for pharmaceutical companies, the side effects you may experience from these new inventions can be devastating.In ìLess Medicine More Health,î Welch fights an uphill battle against a ìFirst Worldî medical dilemma wherein ìtoo much medical care has too little value.î Needless to say, he is not the darling of the medical community. As a physician and professor at Dartmouth Medical School, much of his work revolves around ìthe effects of medical testing.î A few years ago, he received notoriety when he questioned the wisdom of annual mammograms. In this book, he explains seven assumptions the medical profession and general public believe to be true. Unfortunately, some of these suppositions are downright false, while others are just wishful thinking.Below, youíll find a quick overview of those assumptions. But first a caveat: Many physicians do not agree with Welchís attack on preventive medicine practices. Thatís not shocking for two reasons. First, many physicians believe these ìjust-in-case testsî save lives. Second, these routine procedures have become the ìbread and butterî of many medical establishments. So, when Welch offers us the following advice about medical care, ìseek it when ill and all but avoid it when healthy,î he certainly appears to be ìout there!î But does that mean he is wrong?ìAll risks can be lowered.îWell, not all. But if you smoke cigarettes, STOP! Welch says thereís just no arguing with the overwhelming data. Yes, there will always be that one person in a thousand who smokes like a chimney and still gets to blow out the candles on their centennial birthday cake. But for the remaining 999 people, smoking decreases their lifespan, and normally culminates in slow and painful death.But there are scenarios where attempting to reduce risks can be detrimental. In this chapter, Welch examines the ìaggressive treatmentî of high blood pressure in people without type 2 diabetes and the use of hormonal replacement therapy to prevent heart attacks in menopausal women. In both cases, he said these treatments may be ineffective, costly, or may have deadly consequences.ìItís always better to fix the problem.îNot so. Welch warns us, while that is sound advice for a plumbing problem, some health conditions are better managed than ìfixed.î Here, he concentrates on heart problems, such as atrial fibrillation. I was shocked to learn how many cardio-treatments are actually elective procedures. When patients are faced with deciding whether to manage the condition with medication or ìfixî it through surgery, Welch says, ìAct as if it were a major purchase Ö even if someone else is paying for it.î Get a second opinion from ìa doctor who doesnít perform the procedure,î then ask about all optional treatments before moving forward.ìSooner is always better.îNot always, especially in the case of cancer screenings. ìScreening is the systematic search for abnormalities in those who have no symptoms of disease.î Welch balks at the amount of stress and the number of needless treatments that accompany the widespread use of cancer screening. He points to autopsy results that show many people have small spots of cancer ó ìparticularly cancer of the prostate, breast and thyroid gland.î These spots remained isolated, playing no role in the death of the patient.I believe this is the most important chapter in the book. Men, read the statistics! Prostate cancer is still over-diagnosed and over-treated by many physicians. Women, the same is true for breast cancer. Read Welchís research, then decide for yourself whether these screenings are beneficial.ìIt never hurts to get more information.îAs someone who Googles till she drops, I found this chapter disturbing. How can more information be harmful? Welch uses case studies to prove his point. I find the case of ìBruceís Big Heartî to be the most enlightening. Bruce is a doctor who works in the intensive care unit. ìHe felt wellî before his annual checkup, when his doctor talked him into having an EKG. That was followed by an MRI, blood work, and a whole slew of tests; resulting in a diagnosis of ìnonobstructive hypertrophic cardiomyopathy.î See how all of these tests did nothing to improve Bruceís health.ìAction is always better than inaction.îNo, sometimes the best thing we can do for an illness is to give our bodies a chance to heal. This is especially true when we are experiencing low back pain. When 725 patients who had surgery for the pain were compared to ì725 people who did not,î the results were telling. After two years, only 26 percent of those who had surgery were back at work, as compared to 67 percent of those who elected to use physical therapy and time to heal.Welch explains why doctors have a proclivity for action. You wonít like hearing it, but you know it is true: Financial interests can play a big role in the treatments we receive, so we must become our own health advocates. Welch writes that all surgeries are accompanied by ìthe risk of infection, cognitive dysfunction and physical injury,î so it only makes sense to seek alternative treatments before ìgoing under the knife.îìNewer is always better.îWith new medical devices, procedures and drugs being developed each year, we want to believe these inventions always provide better results. But the Dalkon Shield, Vioxx, Thalidomide and metal-on-metal hip replacements are examples of when ìnewî did not translate into ìbetter.î That is the reason Welch advises us to stick to the ìtried-and-trueî methods of treatment whenever possible.ìItís all about avoiding death.îFaced with limited mobility, diminished intellect or chronic pain, many elderly patients are not interested in avoiding death. Sadly, few in the medical community are listening. Thatís why ìone-third of all Medicare patients Ö were seen by 10 or more physicians in the last six months of their lives.î While Welch certainly doesnít suggest denying care to any of these folks, he does question whom those ìend of lifeî chemotherapy or radiation treatments are truly benefiting. Read about lung cancer patients in a palliative care group who lived three months longer than those who were subjected to the last-ditch efforts of modern medicine. Sadly, as Welch notes, avoiding death often comes at the expense of enjoying life.At the end of each chapter, Welch gives us a ìprescriptionî so we can become informed advocates in our own health care. That is why I suggest buying a hard copy of this book and keeping it for future reference.Start the new year with ìLess Medicine More Health.î

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