The Value of Subtraction
The Value of Subtraction
Joy Stepinski, MSN, RN-BC
November 1, 2025
Previously, we discussed the assumption that always treating is best when faced with a health issue. Often, a treatment provides a tangible solution for both patients and healthcare providers. Yet, treatment may not be in the patient’s best interest at all times. There may be value in simply waiting or doing nothing. As we will see, another option may be to subtract a root cause rather than add a new intervention.
In The Pleasure Trap by Douglas Lisle and Alan Goldhamer, the authors suggest that the true solution may not lie in offering more treatments, but in removing the source of the problem [1]. While treating may seem like the best solution, the authors write, “Physicians fail to recognize… the possible value of removing the causes of disease as a method of assisting the body to heal itself” (p. 189). For example, when a person has high cholesterol, a medication in the form of a statin is often prescribed. However, medication often masks the underlying problem to manage the symptoms, rather than addressing the root cause of the illness.
Another example is high blood pressure. High blood pressure affects nearly one-third of the adult population in the United States. To prevent cardiovascular problems, like a stroke or heart attack, a medication is prescribed even for patients with slightly elevated blood pressure. Studies show that there is no benefit from these medications [2]. Of twelve people who take an anti-hypertensive drug for mild hypertension, one person is harmed as a result of the treatment.
A different strategy is to look at the source of the problem. High blood pressure is caused by the excessive consumption of dietary fats and protein [1], as found in animal foods. When the body experiences too much fat, plaques form in the arteries, often leading to heart attacks, congestive heart failure, strokes, diabetes, and other problems. Removal of excess dietary fat can slow the progression of arterial plaques and may even reverse them, so that the cardiovascular system works more effectively.
When making an informed decision, understanding all available options is essential for one’s autonomy over health decisions. Sometimes, subtracting a root cause rather than adding another treatment can lead to significant improvement of a health condition. Carefully weighing the options of each choice, including the benefits and drawbacks, supports self-determination in care. In many cases, subtraction may be of great value, allowing the body to heal naturally when the underlying cause is removed.
References:
1. Lisle, D. J., & Goldhamer, A. (2007). The Pleasure Trap: Mastering the Force that Undermines Health & Happiness. Book Publishing Company.
2. The NNT. (2022). Anti-Hypertensive Treatment for the Primary Prevention of Cardiovascular Events In Mild Hypertension. https://thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/