Some experienced public policy experts and creative thinkers have written books and essays, lobbied governments, implemented changes, and inspired others to take up the cause of 'Less is More' approach to medicine.
We all call it something different (see the glossary for clarification), but many of our goals and ideas are the same. To keep up to date on 'who is doing what,' follow this ever-growing list of people tweeting about Less is More in Medicine:
Less is More twitter list
Many have made significant contributions; a few of the key thinkers are highlighted here:
Dr. G. Michael (Mike) Allan
(bio) - Family Physician, Associate Professor and Director of Evidence-Based Medicine in the Department of Family Medicine of the University of Alberta
He coordinates and teaches the evidence-based medicine curriculum in the family medicine residency program and the community health course. He is the Medical Director of the Toward Optimized Practice Program, which works to expand the depth and spread of evidence-based practice and quality of primary care in Alberta. (CADTH Therapeutic Review Panel)
With Dr. McCormack, Dr. Allan is co-host of Therapeutics Education Collaboration: Medication Mythbusters - Home of the Best Science (BS) Medicine Podcast, @medmyths
Shannon Brownlee
(bio) - Senior vice president of the Lown Institute, former acting director of the Health Policy Program at the New America Foundation, and co-leader of the Right Care Alliance. Having earned an MSc in Marine Science, she now writes about shared-decision making, overtreatment, and the need for change in healthcare policy in her articles and book, Overtreated: Why too much medicine is making us sicker and poorer. @ShannonBrownlee
. . . What happened to Maria could be considered a medical mistake, but not the usual kind, in which the doctor makes the wrong incision in a procedure or worse — operates on the wrong patient. In Maria’s case, she got a surgery that she would not have wanted, had she understood all of her options and the risks of each. How often this kind of error occurs isn’t known — although studies suggest as many as half of some kinds of surgeries are done on patients who would have chosen a different treatment. (from When Patients — Not Doctors — Make Medical Mistakes: Patient error can lead to unnecessary and risky treatment, TIME Magazine)
Dr. Allen Frances
(bio) - Psychiatrist, chair of the DSM-IV task force, and outspoken critic of the DSM-5 which stands to be the next key reference book for psychiatric illness. He is the author of Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. His work emphasizes the dangers of medicalization of normal psychological states, which not only harms those who are healthy, but diverts important resources away from those with severe mental illness.
Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. These challenges are a normal part of being human, and they should not be treated as psychiatric disease. However, today millions of people who are really no more than "worried well" are being diagnosed as having a mental disorder and are receiving unnecessary treatment.
Dr. Paul Glasziou
(bio) - GP, professor of EBM at Bond University, Director of the Centre for Research in Evidence-Based Practice (CREBP), author of several EBM books including Evidence-Based Practice Workbook. He'll be a speaker at the 3rd ISEHC conference in Taiwan in 2014. @PaulGlasziou
His key interests include identifying and removing the barriers to using high quality research in everyday clinical practice.
Dr. Fiona Godlee
(bio) - GP, Chief Editor of the BMJ for the past 8 years, led the establishment of BMJ Clinical Evidence, and has had a prominent role in cultivating the BMJ's Too Much Medicine campaign. Dr. Godlee has dedicated herself to facilitating the application of medical evidence to clinical practice. She also has a way with words, as might be expected in an editor:
"Combatting excess is a contemporary manifestation of a much older desire to avoid doing harm when we try to help or heal."
Dr. Gordon Guyatt
(bio) - Clinical Epidemiologist, Professor at McMaster University. Coined the term "evidence-based medicine." A prolific writer, he received the Order of Canada in 2012 for his contribution to advancing the field of Evidence-Based Medicine.
Areas of interest include: the dissemination of concepts of evidence-based medicine to health workers and health-care consumers; the methodology of clinical practice guidelines and medical decision-making; systematic review methodology; and ascertaining patients' values and preferences.
Dr. Iona Heath
(bio/interview) - Family physician (retired), former president of the Royal College of General Practioners (RCGP) in the UK, and enduring philosopher and proponent of the role of the general practitioner. She was an editorial adviser for the British Medical Journal and remains a prolific contributor with some deeply perceptive and courageous papers like It is Not Wrong to Say No. @Iona_Heath
". . . overdiagnosis and overtreatment have become disturbingly pervasive within contemporary medicine and are now deeply embedded within healthcare systems around the world. They have permeated and polluted the drug and medical technology industries, medical research and regulatory bodies, clinical practice, payment systems, guideline production, and national healthcare systems. They are the cause of an astonishing amount of waste and harm." (from Overdiagnosis: when good intentions meet vested interest, BMJ)
Ivan Illich
(bio) - a now deceased Austrian philosopher, catholic priest, and social critic. He wrote Medical Nemesis (aka Limits to Medicine) attacking contemporary Western medicine and iatrogenesis, back in 1974. The original article appeared in the Lancet, and has been reprinted in the Journal of Epidemiology and Community Health under the same title. From that text:
"Rising irreparable damage accompanies industrial expansion in all sectors. In medicine these damages appear as iatrogenesis. Iatrogenesis can be direct, when pain, sickness, and death result from medical care; or it can be indirect, when health policies reinforce an industrial Organisation which generates ill-health: it can be structural when medically sponsored behaviour and delusion restrict the vital autonomy of people by undermining their competence in growing up, caring, ageing; or when it nullifies the personal challenge arising from their pain, disability, and anguish.
Most of the remedies proposed to reduce iatrogenesis are engineering interventions . . . These so-called remedies generate second-order iatrogenic ills by creating a new prejudice against the autonomy of the citizen."
Dr. Wendy Levinson
(bio) - Internist, collaborator on the Choosing Wisely Canada campaign, Sir John and Lady Eaton Professor and Chair of the Department of Medicine at the University of Toronto.
She is a national and international expert in the field of physician-patient communication and the physician-patient relationship. Her research has spanned a number of highly relevant policy issues, including the relationship of medical malpractice to breakdowns in communication, the effectiveness of primary care physicians and surgeons in helping patients to make informed decisions, and the relationship of communication to patient satisfaction. Dr. Levinson has contributed to large-scale training programs designed to enhance the skills of primary care physicians and surgeons in effective communication with their patients (from BRIDGES)
Dr. Margaret McCartney
(bio) - GP in Glasgow, Scotland, and writer for a range of media, newspapers and journals including the British Medical Journal, and BBC Radio 4′s Inside Health. She is the author of The Patient Paradox: Why sexed-up medicine is bad for your health and continues to be vocal about issues relating to evidence in medicine, the harms of screening, and the state of healthcare under the NHS in media and on her Blog. @mgtmccartney
In a Guardian article, Patients deserve the truth: health screening can do more harm than good, she wrote:
It is precisely because screening is a mixed bag of benefit and harm that no one should impose their own values onto another person. Yet at present, NHS screening programmes are judged by how many people attend, and not by how many people make an informed choice to attend – or not . . .
We need a debate about the cost-effectiveness of our screening sacred cows, but we also need a debate about how to give autonomous adults fair information about screening that respects their right to decline. Until patients are given unbiased information – including that screening can maim as well as help – we will continue to fall short of the ideal of patient consent, "no decision about me – without me".
Dr. James McCormack
(bio) - Pharmacist, Professor, Faculty of Pharmaceutical Sciences at The University of British Columbia, producer of humorous musical videos - like Make it Easy - that drive home the point.
His focus is shared, informed decision making using evidence based information and rational therapeutic principles . . .
The overall philosophy of the [Therapeutics Education Collaboration] (TEC) is to encourage clinicians to engage in shared informed decision-making, critical thinking, and exercise some degree of healthy skepticism when it comes to the use of new and old medications. (UBC Pharmaceutical Sciences)
With Dr. Allan, Dr. McCormack is co-host of Therapeutics Education Collaboration: Medication Mythbusters - Home of the Best Science (BS) Medicine Podcast, @medmyths
Dr. Victor M. Montori
(bio) - Endocrinologist, "father" of minimally-disruptive medicine, proponent of shared decision making. Blogger on minimally disruptive medicine and pioneer of shared decision making with the Mayo Clinic. Originally from Peru, he did postgraduate training with the Mayo Clinic and also trained under Dr Gordon Guyatt at McMaster University. @vmontori
"Shared decision making enables patients and clinicians to share the best available research evidence and make decisions that better reflect the patient's values and preferences. Minimally disruptive medicine focuses on pursuing the patient's goals (preventing premature death, feeling better, and living without hindrance from complications of disease or treatment) while reducing the treatment burden."
Ray Moynihan
(bio) (website) - Academic researcher, writer and author, with a background as a respected journalist, based in Australia. He wrote Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us all into Patients and is now working on his PhD, on the subject of Overdiagnosis, at Bond University. He wrote one of the seminal papers on the subject, quoted below, for the BMJ in 2002. @RayMoynihan
"Most doctors believe medicine to be a force for good. Why else would they have become doctors? Yet while all know medicine's power to harm individual patients and whole populations, presumably few would agree with Ivan Illich that “The medical establishment has become a major threat to health.” Many might, however, accept the concept of the health economist Alain Enthoven that increasing medical inputs will at some point become counterproductive and produce more harm than good. So where is that point, and might we have reached it already?" (from Too much Medicine?, BMJ)
Dr. H. Gilbert Welch
(bio) - General Internist, MPH, and Professor of Medicine, Community & Family Medicine at The Dartmouth Institute. Dr. Welch focuses on the general effects of screening and early diagnosis – and, in particular, the overdiagnosis of cancer. He is the author of Should I be Tested for Cancer? Maybe Not and Here’s Why (2004), an author of Overdiagnosed: Making People Sick in the Pursuit of Health (2011) and is completing his next book: 7 Assumptions that Drive Too Much Medical Care (2015). He, like most people interested in Less is More medicine, seems to have a great sense of humour, as evinced by some of his article titles, like If You Feel O.K., Maybe You Are O.K, in the NY Times.
[his] research focuses on the problems created by medicine's efforts to detect disease early: physicians test too often, treat too aggressively and tell too many people that they are sick.
Dr. Leana Wen
(bio) - Emergency Medicine Physician and Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University. Dr Wen drew from her family's experience with the healthcare system to author When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. @DrLeanaWen
Global change requires more than pills and individual-level change: it hinges on concerted education and mobilization . . . My passion is to communicate to the public—to you—as a method of effecting change.
I strive to practice this “right care” in every encounter with every patient I treat in the E.R. I say to my patients, “I’m Leana Wen, I’m your doctor. I belong to an initiative called ‘Who’s My Doctor’, that aims for transparency in medicine. I accept no money from drug companies or device companies. I do not make any more from ordering more tests or procedures on you, and I also don’t make more for ordering less. I’m telling you this so that you can be sure that everything I do for you is in your best interest.” In other words, this is me. Now tell me about you. This is the beginning of our partnership. We’re in this together. (DrLeanaWen.com)
(To find out more about the author of this site and why I am particularly interested in this kind of medicine, please see About Dr Otte)
See a mistake? Or is someone important missing from this page? Send in their name and link to their bio (or your own, if you are the important person!) or tweet the details to @LessIsMoreMed