Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

Reviewed by Larry Siegel

I do not read books on matters medical. Until. Having conducted more than half my life guided by the philosophy that less is more, I was drawn to Less Medicine, More Health like a bee to nectar. I was not disappointed. Fair warning: if you are comfortable with conventional medical care, with its plethora of diagnostic tests and pharmacological solutions, do not, I repeat, do not read this book. If, however, you harbor, with me (healthy) reservations that all is not healthy in the health-care world, then this book becomes a must-read. Dr. H. Gilbert Welch has turned the prevailing assumptions that drive medical care on their ears. I have the notion that were the author to appear before a jury of his peers, he would be judged a heretic and burned at the stake.

The overriding premise of the book is, in the words of the author, …as a society, we have overstated the benefits of medical care and underplayed its harms.” He then proceeds to document, quite convincingly, the benefits that are overstated and the harms that are underplayed. Each chapter addresses one of seven assumptions: All risks can be lowered. It’s always better to fix the problem. Sooner is always better. It never hurts to get more information. Action is always better than inaction. Newer is always better. It’s all about avoiding death. No. No. No. No. No. No. And no.

Using personal observation resulting from his twenty-five years as a primary care practitioner and first-hand accounts by friends or acquaintances, the author has provided compelling arguments to support his assertions. There are (quite necessarily) statistics and references to studies, but the author’s assertions are not mired in them. Quite the contrary, Welsh has injected a healthy dose of the personal in his accounts, resulting in, for this reader, a book far more engaging and far more persuasive than one not so injected. On a deeply personal level, he writes of health issues regarding his wife, the end-of-life experiences of his father and mother, and medical matters related to himself. The book is not bereft of value judgments but they are clearly spelled out (“Medicine has been increasingly dominated by the interest of making money.”)

Most importantly, H. Gilbert Welsh does not present himself as some personage on a pedestal conveying some holier-than-thou attitudes. Rather he projects himself as the guy-next-door who just happens to know something about epidemiology (probably because he is). If some notion sounds like shit, guess what, Welsh tells you it sounds like shit. Despite the seriousness of the subject matter, humorous moments appear with regularity. We learn his high school friends were Eee, JB, K-dog, and the M.A.N. I need not tell you (though I am) that this is not the fodder for books of this genre. Which makes it that much more appealing. And effective.

I may be criticized for focusing more on the author and less on the content in this review, but it is a package deal, my goal being to pique your curiosity. I urge you to read this book. If your library does not have and will not buy it, use inter-library loan (government spending at its finest). Or, buy it, with the knowledge that H. Gilbert Welch, M.D. has directed all royalties to grassroots charitable organizations in northern New Hampshire and Vermont (as he has done with his previous two books). Ask your doctor to read it. If he or she declines (or, worse, begins to criticize it), maybe it is time to find another practitioner. Kathy and I are fortunate. When, last December, we went for our annual ‘physical,’ our doctor (who, admittedly, has always been ‘left-of-center’ in his practice) sat us down and chatted for a period of time on any matters we wished to chat about. It was a check-in, not a check-up, and we left a bit confused by it all. Then we read Less Medicine, More Health and became not confused at all.