The People's Perspective on Medicine

Show 984: Less Medicine, More Health

The assumptions we make about medicine drive up health care costs but underminine health.
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Less Medicine, More Health

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Americans tend to equate more tests and more aggressive treatment with better quality care. This approach does result in more expensive care. The US spends more on health care per capita than any other country in the world. But we lag behind other industrialized nations on important measures of public health.

Challenging Assumptions

Many of our assumptions about modern medicine are driving up costs and covering up potential downsides to medical interventions. Dr. Gil Welch, a leading analyst of health care policy, challenges these assumptions. In our conversation, he explains why we shouldn’t buy in to the ideas that it’s better to fix a problem, sooner rather than later, and that there is a pill for every ill.

This Week’s Guest:

H. Gilbert Welch, MD, MPH, is professor of medicine and community and family medicine at the Dartmouth Institute and the Geisel School of Medicine at Dartmouth. He is also adjunct professor of business administration at the Tuck School of Business and adjunct professor of public policy at Dartmouth College.

His books include: Should I Be Tested for Cancer? Maybe Not and Here’s Why; Overdiagnosed: Making People Sick in the Pursuit of Health (with Lisa Schwartz, MD, and Steven Woloshin, MD); and his most recent: Less Medicine More Health: 7 Assumptions That Drive Too Much Medical Care. You can watch a seven-minute video about the seven assumptions he addresses here.

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The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Thank you for this timely discussion. In view of current medical and health issues and the high cost of medical intervention it behooves us to all consider what our dollars pay for and the benefit of more verses less medical procedures relative to outcomes.

This is my second response. I sent a response to this show about a week ago. All of the expressed thoughts and opinions here seem to AGREE with the whole need to do away with “unnecessary ” medical treatment. Is anyone asking the question of WHO deems something “necessary “? I have had clinic doctors question me whether something is “necessary ” when I want to pay for tests MYSELF due to my doctor being so booked out for months. Insurance wouldn’t even be involved! I question the doctors that question patients when it comes to knowing their own body and what “symptoms” may actually be something that needs to be looked into further. That is why I commented on the privilege of Dr. Gil Welch’s wife being taken so seriously with infectious disease specialists looking into her “fever and tiredness” as a symptom of something greater. That is NOT common among folks who are not married to a doctor or have “affordable” health care. The folks with “affordable” insurance are looked upon as “wasteful” if they want symptoms investigated by specialists.

When we moved to our current location I found all the appropriate doctors that I usually go to. The problem was that all took many tests of just about everything even though I didn’t have any problems. Then these doctors wanted to track anything that wasn’t absolutely normal. So checkups went from 1 year to 3 months so see “…… how this or that piece of data is progressing”. After a while I found myself being overwhelmed with data, numbers, and tracking of changes. All the while I felt great. So now I go to the docs when I have a real problem. Things change and I don’t believe that anyone really knows what numbers should be as we get older.

This was a great show, as most of the Peoples Pharmacy shows are…however, I have to bring to Dr. Welch’s attention that the “shoe was on the other foot” so to say, regarding his wife, her rare “tick borne” disease, and the privilege of having an infectious disease specialist look into a basic fever being a side effect of something greater.

In my eyes, this was over diagnosis that just happened to uncover something deeper. I am sure there would have not been an intervention with a disease specialist if her husband had not been a doctor and she didn’t have great medical coverage. I have multiple friends and family who have had misdiagnosed disease for many years, leading to poor quality of life and health because medical “investigation” seemed “unnecessary”.

Your wife is very lucky to be taken so seriously with her “tick borne” illness. Her high fever and bed rest being “out of character” as described by HER HUSBAND wouldn’t mean a darn thing in the eyes of many doctors. Most people wouldn’t have a doctor look into fever, “out of character” tiredness, and feeling cold as a reason to bring in an infectious disease specialist.

It is real easy to say that “this is an example of medicine NOT being wasteful” when it is YOUR family, Dr. Welch. Remember that the next time you deem tests or care as “unnecessary” for someone else’s quality of life or health.

Great discussion on healthcare, ordering the right tests and not over-prescribing unnecessary tests and diagnostics that don’t impact a patient’s health, but only deplete their bank accounts (and the system’s bank account).

What a timely show! My mother is 95 and has been diagnosed with Alzheimer’s. She entered a nursing home in January after breaking her ankle, and while she’s doing quite well (had the cast removed a week ago and is using a walker), I was starting to wonder about the various medications being prescribed. Even before this happened, I was frustrated by the number of visits to the doctor, just to do bloodwork and check her vitals! She was fine!!

We are extremely fortunate to have a wonderful palliative care physician who comes to the nursing home and works as a consultant for the clinic/hospital in our community. So, my husband and I had a meeting with him last week, and finally, I feel like everyone is on the same page!

He met my mother first, checked her heart and lungs, and talked to her briefly. Then we met with him privately. He had all her medical information, including prescriptions. He was so compassionate and yet, practical. He helped us cut back and/or eliminate some of the most expensive and least effective medications. We were able to determine how to take care of her ongoing needs in a way that made sense. In our case, we wanted Mom to live, and at some point, die as naturally as possible. Quality versus quantity is our main goal.

I can’t begin to tell you how helpful and reassuring it is to have this doctor as an advocate. And listening to your show added to our belief that we are doing the right things for Mom!

I’ve read Overdiagnosed, and wanted to let everyone know that it is excellent! I would also encourage everyone to read Culture & Medicine by Payer, these two books could save your life (I have no personal or financial ties to anyone).

Good luck to everyone!

Too much intervention: After I was diagnosed with prostate cancer in 1995, my urologist insisted on a prostatectomy, which would have left me incontinent and impotent. I refused and treated myself naturally (herbs, exercise, mind-body, etc.). For the last 20 years, my PSA has been normal.

Too little intervention: I recently tore my rotator cuff. The doctor just X-rayed me and found no broken bones and sent me to physical therapy. I was skeptical and finally got them to approve an MRI. It showed a large tear requiring surgery. Had I got the MRI to begin with, I would have avoided further damage from “therapy” and at least a month of shoulder pain.

It’s all about yin-yang balance.

Great article. Australia spends like USA in medical care too. I take Pharma drugs and alternatives for my Rheumatoid. Wish there were some ‘body’ that could look at combination of the two. I take bitters drops in tonic water after a meal helps indigestion. VD3 is imperative even in Australia’s warm climate as we spend more time indoors. For my osteoporosis have started VK2 (MK7) with my calcium.

Yes I think we are sometimes being over diagnosed (I was incorrectly diagnosed). Every 3 months specialist wanted to see me but was not necessary as I got blood tests from GP to see if anything wrong ..if so then I go specialist.

I’m glad to see that someone is collecting the data on this. I would assume that most people who follow People’s Pharmacy already think along similar lines.

As a public health professional for more than thirty years, I would like to add my support to Dr. Welch’s statements. The U.S. spends much more per person on medical care, but gets much less health in return. This video explains some of the reasons why this is true.

I do agree that cancer is over-diagnosed. I was diagnosed 2 years agi with DCIS stage0 and had 5 surgeries and 6 weeks of radiation, with more to go! Teresa

I had a recent experience with a medication that my doctor prescribed for me. First let me say I am 78 yrs of age and pretty healthy. I have always had excellent numbers as far as my cholesterol is concerned. Suddenly my bad cholesterol went up and the doc. put me on a statin drug called simvastin, which is generic for lipitor. I took it for about 2 months and no problems. Suddenly I started getting severe cramps in my legs, and also in my fingers during the day as well as evening. I know my magnesium level is ok so it couldn’t be that. I certainly know my own body, so I decided not to take the simvastin for a few days to see if that was causing it, and the problem went away. I then called my drs office and told them I wanted to take a CPK blood test to make sure there was no problem with the enzymes in my body . Everything came out fine. Just remember that a physician is trained in medical school to prescribe medications.The problem is that only treats the symptoms not the underlying cause. Be very careful because some meds cause more harm to our bodies than anything else. I fine that changing your diet and finding out about proper nutrition is the best way to go. I did the right thing and no longer have to take that med.
Another problem was about 8 years ago a different dr. put me on a blood pressure medication called lisinoprel and told me I would be on it for the rest of my life. I did not complain but after about 2 years and a 20 lb weight loss and by the way I was not fat., I began feeling not so good and after checking my blood pressure found that my pressure was extremely low so I stopped the medication by myself. I no longer use that dr. Have excellent pressure. Last time it was 107 over 77. So you can’t always believe everything that your dr. says .Know your own body.

BRCA? Tamoxifen?

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