There is nothing to sell in telling someone to do less, which is exactly why you hear it so rarely. Yet the interventions with the strongest evidence behind them are almost all subtractions: stop smoking, treat the high blood pressure, fix the sleep, cut the excess alcohol, stop the medication that is no longer earning its place.
Addition has the opposite profile. A growing stack of supplements and protocols, each with a small and uncertain effect, interacting in ways no one has studied. It feels productive. It photographs well. It rarely moves an outcome that matters.
In serious primary care, I find myself deprescribing more than prescribing. The question I keep returning to is not what we can add, but what we can safely take away. Subtraction is unglamorous, well proven, and usually the better bet.
Sukhjit "Sarge" Takhar, MD, SM is a physician-scientist in evidence-based longevity medicine and Co-Founder and Chief Medical Officer of PrimaryMD.