The case for less medicine
Choosing wisely means questioning medical tests, treatments and procedures before they happen, keeping the ones that genuinely help, and skipping the ones that add cost and risk without adding benefit. It is the plain idea at the heart of a growing movement inside medicine itself: that more care is not automatically better care, and that patients are safer when every intervention has to justify itself. This page is an independent, neutral reference to that movement. It is not medical advice, and it is not affiliated with any conference, organization or prior owner of this domain.
For most of the twentieth century, the assumption ran one way: a new scan, a new pill, an earlier diagnosis, one more test all seemed like progress. Over the last two decades, a large body of research and a set of named campaigns have complicated that story. They argue that some proportion of modern care is wasteful, and a smaller but real proportion is actively harmful. The response is not to reject medicine. It is to aim it more precisely.
Why “more” is not always better
Every test and treatment carries a balance of possible benefit and possible harm. When the potential benefit is large, the balance is easy. The problem arises in the wide grey zone where the benefit is small, uncertain or absent, and the harm is quietly accumulating. That harm takes several forms: side effects from drugs, complications from procedures, anxiety and further testing triggered by ambiguous results, and the labeling of healthy people as patients.
The scale matters most with medication. Taking more medicine than a body needs does not simply do nothing; it can cause real damage. Every drug is processed by organs, and both the liver and the kidneys carry that load. Excess or unnecessary drugs are one reason drug-induced injury to these organs happens at all. The point is not to frighten anyone away from prescribed treatment, which should never be stopped on the basis of a web page, but to make the trade-off visible: a medicine only earns its place when its expected benefit outweighs the burden it puts on the body.
How much is “too much” medicine?
There is no single number that defines too much, because it depends on the person, the drug and the goal. A useful way to think about it is that a treatment becomes excessive when it is unlikely to change the outcome that matters to the patient, yet still exposes them to side effects, interactions or cost. Several patterns recur:
- Polypharmacy. Older adults in particular can accumulate long lists of medicines over years, where each was reasonable when started but the combination now causes more harm than good, including dizziness, falls, confusion, constipation or diarrhea.
- Treatment of numbers, not people. Prescribing driven by a slightly abnormal reading rather than by how the person actually is, where the label matters more than the benefit.
- Cascades. One test produces an incidental finding, which triggers another test, which triggers a treatment, none of which the person needed.
Signs that someone may be experiencing effects of excess medication are best assessed by a clinician who knows the full picture, not self-diagnosed. What a person can reasonably do is keep an up-to-date list of everything they take, including over-the-counter and herbal products, and ask a pharmacist or doctor to review it periodically. In a genuine emergency, such as a suspected overdose, the response is to contact emergency services or a poison control line immediately rather than to wait.
The campaigns pushing back
Several organized, credible efforts have grown up to translate this thinking into everyday practice. They are cooperative rather than confrontational: their audiences are doctors and patients together.
Choosing Wisely
Launched in 2012 by the ABIM Foundation in the United States, Choosing Wisely asks medical specialty societies to publish lists of tests and treatments that are commonly used but often unnecessary. It has since spread to more than twenty countries. The campaign also gives patients a short set of questions to ask before agreeing to any intervention. The dedicated overview of Choosing Wisely: fewer tests, better care explains how those lists and questions work in detail.
The “Too Much Medicine” initiative and Preventing Overdiagnosis
The medical journal BMJ runs a long-standing “Too Much Medicine” campaign that publishes evidence on overdiagnosis and overtreatment. Alongside it, the international Preventing Overdiagnosis conference brings together researchers, clinicians and patient advocates each year to study how healthy people end up diagnosed and how to wind that back safely.
Quaternary prevention
A concept named by the Belgian physician Marc Jamoulle, quaternary prevention is the deliberate practice of protecting people from unnecessary or harmful medicine and offering ethically acceptable alternatives. It sits alongside the familiar primary, secondary and tertiary prevention as a fourth safeguard focused on the harm medicine itself can cause.
Deciding with patients, not for them
The practical engine of all these campaigns is shared decision-making: the clinician and the patient weigh the real options together, using honest absolute numbers rather than vague reassurance or alarm. Instead of a reflexive “let’s run the test”, the conversation becomes “here is what the test can and cannot tell you, here is the chance it helps, here is the chance it leads to harm, and here is what matters to you.” Decision aids and option grids exist precisely to make those numbers concrete.
This approach connects the movement to the wider question of overmedicalisation, where the boundaries of illness expand to cover more of ordinary life. Shared decision-making is one of the strongest defenses against that drift, because it puts the patient’s own goals back at the center of the choice.
What the movement is, and is not
It is worth being precise about the claim. The case for less medicine is not a claim that medicine is bad, that vaccines or antibiotics or cancer treatment should be avoided, or that patients should second-guess their doctors alone. It is the opposite of anti-medicine: it is an effort to preserve trust in medicine by removing the waste and harm that erode it.
| The movement says | The movement does not say |
|---|---|
| Question tests and treatments that lack clear benefit. | Refuse all tests and treatments. |
| Use real numbers to weigh benefit against harm. | Ignore evidence or trust intuition alone. |
| Recognize that unnecessary drugs can burden the liver and kidneys. | Stop prescribed medicine without medical guidance. |
| Make the patient’s goals central to every choice. | Hand every decision to the patient without support. |
Read together, the pages in this section describe a coherent shift: from doing everything possible to doing what actually helps. Choosing Wisely supplies the practical lists and questions, quaternary prevention supplies the ethical frame, Preventing Overdiagnosis supplies the research, and shared decision-making supplies the method. The common thread is modest and durable, which is that good medicine is measured by outcomes for real people, not by volume of activity.