Massachusetts Medical Society's Physician Focus

January 2017

Too Much Medicine?

PROGRAM HIGHLIGHTS:

  • Conventional wisdom in medicine says that more care leads to better health, as annual physicals and regular screenings lead to early detection of diseases.
  • Research shows, however, that many medical tests and procedures are unnecessary and in some cases, can cause harm.
  • Patients should talk to their doctors and inform themselves about the positives and negatives of testing and screening.

Physicians and patients have long believed that more care leads to better health. Annual check-ups and recommended regular screenings would serve to catch problems early, preventing diseases from progressing. What could be bad about that?

Increasingly, however, more physicians are wary about the problems caused by ‘too much medicine.”

“We’ve all been taught that sooner is always better,” says H. Gilbert Welch, M.D., “particularly for a disease like cancer, [but] the basic problem is that whenever we look for early forms of disease, we find a lot more than we expect. And that means that some of what we’re finding is never going to be relevant to the patient.”

Dr. Welch, a general internist and Professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Practice, shares his experience and research on the topic of ‘too much medicine’ in the January edition of Physician Focus with the Massachusetts Medical Society. Hosting this edition is Dale Magee, M.D., a past president of the Society and Professor Emeritus of Obstetrics and Gynecology at UMass Medical School.

Dr. Welch, also the author of several best-selling books including Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care, says that the very nature of early detection is to look for things in their early form, but that leads to “finding a lot of forms that don’t matter.”

The reality, says Dr. Welch, is that “all treatments have some harms, and that means some people are being harmed for something that was never going to bother them.”

The downside of early detection, says Dr. Welch, can be “a recipe for turning well people into patients unnecessarily.”

Dr. Welch acknowledges that in medicine today there is a tremendous push for more testing, as there’s a lot of money at stake. He also believes that many doctors recognize the problem and that the system has been pushed in this direction.

Dr. Welch believes that it’s a good thing to see your doctor when there’s something wrong: and that screening of populations that are at risk makes sense. But he also urges patients “to be a little careful about approaching the system when we feel well because there’s such a push to try to find things that are wrong.”

Watch the video above, for more conversation about too much testing, with specific examples focusing on prostate, breast, and thyroid cancers.

Text:
MMS/Richard Gulla

Dr. Gilbert Welch delivered the 41st Annual Garland Lecture, “Less Medicine, More Health,” at the Francis A. Countway Library of Medicine on November 3, 2016.
Left to right; Dale Magee, M.D., Dr. Gilbert Welch, M.D., M.P.H.
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