Less Medicine, More Health

The author of the highly acclaimed Overdiagnosed describes seven widespread assumptions that encourage excessive, often ineffective, and sometimes harmful medical care.
 
You might think the biggest problem in medical care is that it costs too much. Or that health insurance is too expensive, too uneven, too complicated—and gives you too many forms to fill out. But the central problem is that too much medical care has too little value.

Dr. H. Gilbert Welch is worried about too much medical care. It’s not to deny that some people get too little medical care, rather that the conventional concern about “too little” needs to be balanced with a concern about “too much”: too many people being made to worry about diseases they don’t have—and are at only average risk to get; too many people being tested and exposed to the harmful effects of the testing process; too many people being subjected to treatments they don’t need—or can’t benefit from.

The American public has been sold the idea that seeking medical care is one of the most important steps to maintain wellness. Surprisingly, medical care is not, in fact, well correlated with good health. So more medicine does not equal more health; in reality the opposite may be true.

The general public harbors assumptions about medical care that encourage overuse, assumptions like it’s always better to fix the problem, sooner (or newer) is always better, or it never hurts to get more information. Less Medicine, More Health pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, Dr. Welch notes that while economics and lawyers contribute to the excesses of American medicine, the problem is essentially created when the general public clings to these powerful assumptions about the value of tests and treatments—a number of which are just plain wrong.

By telling fascinating (and occasionally amusing) stories backed by reliable data, Dr. Welch challenges patients and the health-care establishment to rethink some very fundamental practices. His provocative prescriptions hold the potential to save money and, more important, improve health outcomes for us all.

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Less Medicine, More Health

Mosby"s Dictionary of Medicine, Nursing & Health Professions, 9th Edition

So much more than just a bestselling dictionary, Mosby’s Dictionary of Medicine, Nursing & Health Professions, 9^th Edition is a one-stop reference to help you make sense of the complex world of health care. It features over 56,000 authoritative definitions, 45 appendixes, a color atlas of the human body, online resources, and more than 2,450 full-color illustrations – nearly three times more than any other dictionary available – making it an indispensable reference for students and professionals alike.

• UNIQUE! More than 2,450 color photographs and line drawings
demonstrate and explain complex conditions and abstract concepts.



• A Color Atlas of Human Anatomy contains 43 pages of clearly labeled drawings for easy A&P review and reference.




• Over 56,000 comprehensive, authoritative, high-quality definitions – including expanded definitions for selected entries, particularly major diseases, disorders, and procedures – offer the latest information on pathophysiology, treatment and interventions, and nursing care.




• 23 appendixes – 13 in the dictionary and 10 on the companion Evolve website – offer quick access to useful reference information, such as lab values, symbols and abbreviations, language translation guides, pharmacology, infection control standards, conversion tables, and clinical calculations.




• A strict, common-sense alphabetical organization with no subentries makes it easy to find key terms and definitions.

• NEW!
Over 300 new and updated illustrations visually clarify key definitions and reflect current health care practice and equipment.



• NEW! Approximately 11,000 new and revised definitions reflect the latest developments in health care, drugs, and nursing terminology.




• NEW! Editor Marie O’Toole, EdD, RN, FAAN lends her expertise to this new edition, reviewing and revising all definitions and assembling a team of leading consultants and contributors.

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Mosby"s Dictionary of Medicine, Nursing & Health Professions, 9th Edition

Injectable diabetes medicine drives down weight, too, research finds

The diabetes medication liraglutide helped more than twice as many obese subjects in a clinical trial lose 5% of their body weight, and more than three times as many lose a tenth of their body weight, compared with subjects taking a placebo, according to new research.

The drug also appeared to reduce dramatically the risk of developing type-2 diabetes among those taking it. Compared with subjects getting liraglutide, those getting a placebo medication were eight times likelier to be diagnosed with type-2 diabetes during the 12-month trial.

The injectable drug, marketed as Saxenda and produced by Novo Nordisk, was approved last December by the U.S. Food & Drug Administration as a weight-loss drug, partly on the strength of the just-published clinical trial. At a lower dose of its active ingredient, liraglutide (1.8 milligrams vs. 3 millilgrams), Saxenda is marketed as Victoza, a diabetes medication.

Saxenda is the fourth prescription medication to be approved for weight loss by the FDA in the past three years. It joins the drugs Belviq (lorcaserin), Qsymia (a combination of phentermine and topiramate) and Contrave (a combination of naltrexone and bupropion) in the newly fortified arsenal of pharmaceuticals aimed at helping the nation’s 78 million obese adults shed excess weight.

In findings published this week in the New England Journal of Medicine, researchers recruited 3,371 subjects who did not have diabetes but who had a body-mass index of 30 or greater — classifying them as obese — or who had a BMI between 27 and 30 (overweight) and had high blood pressure or a worrisome cholesterol profile.

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Diet and exercise alone are no cure for obesity, experts say

Melissa Healy

At long last, a group of respected physicians and obesity researchers has stepped forward to challenge the facile bromide that America’s weight issues can be easily fixed by diet and exercise.

At long last, a group of respected physicians and obesity researchers has stepped forward to challenge the facile bromide that America’s weight issues can be easily fixed by diet and exercise. ( Melissa Healy )

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While all got counseling to reduce their caloric intake and increase their physical activity, 2,437 gave themselves once-daily subcutaneous injections of liraglutide, a bioengineered medication that stimulates insulin secretion, slows the emptying of food from the stomach and reduces appetite. Another 1,225 study subjects injected themselves daily with a sham medication.

While 65% of patients getting the placebo medication lost weight, on average 5.7 pounds after a year, of the group that took Saxenda, 92% lost weight, an average of 17.6 pounds after a year.

Among those taking Saxenda, 14.4% lost more than 15% of their body weight (vs. 3.5% of those taking a placebo); 33.1% lost more than 10% of their body weight (vs. 10.6% on placebo); and 63.2% lost at least 5% of their body weight (vs. 27.1% of those on placebo).

Those taking Saxenda also showed greater improvements in metabolic function, blood pressure and cholesterol profiles than did those getting a placebo injection.

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FDA approves lorcaserin, first weight-loss drug since 1999

Melissa Healy, Los Angeles Times

Once the Drug Enforcement Administration clears it, the drug will be marketed in the U.S. under the name Belviq. But the FDA’s approval comes with a warning.

Once the Drug Enforcement Administration clears it, the drug will be marketed in the U.S. under the name Belviq. But the FDA’s approval comes with a warning. ( Melissa Healy, Los Angeles Times )

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“Given previous disappointments with various weight-loss strategies, these are welcome findings,” wrote endocrinologists Elias S. Siraj and Kevin Jon Williams, both of Temple University School of Medicine, in an accompanying editorial.

At the same time, Siraj and Williams wrote, “liraglutide is no cure.”

With a price tag of $1,000 per month, Saxenda’s cost will be a considerable issue, especially as obese patients may need to take liraglutide “indefinitely, like statins,” to maintain their weight loss, wrote Siraj and Williams. In a group of participants who were randomly chosen to discontinue the medication after 56 weeks, the average weight regained in 12 weeks was 6.4 pounds.

In approving Saxenda last December, the FDA also required Novo Nordisk to conduct additional studies to determine whether it increases the risk of breast or thyroid cancers — both concerns raised in preliminary trials. Siraj and Williams acknowledged both concerns need to be addressed with further research. But they agreed with the authors of the newly published research that higher rates of breast cancers seen in those taking Saxenda were probably the result of improved detection in women who had lost more weight.

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Injectable diabetes medicine drives down weight, too, research finds