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Ep. 55 Waste in Healthcare: Is the Narrative Too Simplistic?

Lisa Rosenbaum, MD

It doesn’t take great insight to assert that healthcare waste is rampant.  There is an obvious epidemic of testing and treatments that make no difference in patients’ lives or could possible even harm.  But what is the cause of the epidemic and what should be done about it?  In the last decade, a popular narrative has emerged, claiming that the waste has obvious causes and remedies.  That narrative, however, overlooks the complexities of the problem and the trade-offs and potential harms of the remedies proposed.

Our guest to discuss the “Less-Is-More” movement is Lisa Rosenbaum, MD, one of the best medical writers of our generation.  Dr. Rosenbaum is a national correspondent for the New England Journal of Medicine, a cardiologist at the Brigham and Women’s Hospital, and an Assistant Professor of Medicine at Harvard Medical School.


Lisa Rosenbaum, MD. Twitter


Lisa Rosenbaum.  The Less-Is-More Crusade—Are We Overmedicalizing or Oversimplifying? (2017 New England Journal of Medicine.  Free preview  available)

Lisa Rosenbaum. Let Fear Guide Early Breast Cancer Detection. (2015, Open access in The New York Times)

Lisa Rosenbaum.  The Problem With Knowing How Much Your Health Care Costs.  (2013, Open access in the New Yorker)

Michel Accad. The Apostles of Less-Is-More (blog post on Alert and Oriented)

Michel Accad. On Squandering Medicare’s Money (blog post on Alert and Oriented)

Michel Accad. Overdiagnosis: The Disease That Cannot be Diagnosed. (blog post on Alert and Oriented)


Ep. 12 John Mandrola: The Case for Less-Is-More


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1 Comment

  1. Vann Boseman on 01/10/2019 at 3:47 PM

    As a patient it is hard to know what to advocate for or what personally I should pursue in terms seeking to understand risk. For me, in some ways, taking risks adds adventure to life. But I always want to understand any risk to the best of my ability.

    I congratulate Accad for approaching the problems of healthcare from a realistic approach of liberty of the original intent sort.

    What if there could be studies concerning LSD micro-dosing? There would likely be so much uncertainty in pursuing such tests for participants. But there seems to be a growing number of people who would like to see such tests done, and would passionately participate. IQ cannot be discussed rationally. But at least if something could possibly ameliorate a perceived dramatic lowering of IQ in the West, then making such a thing possible on an individual level should, morally, be pursued if tests showed that it could make a practical difference.

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