Dr. Steven Itzkowitz faced a familiar decision at Mount Sinai in New York: a healthy 85-year-old patient had reached the screening interval for another colonoscopy. She met all the standard criteria. But this time, he paused. She was taking blood thinners for cardiac stents, which meant temporarily discontinuing them for the procedure—adding real risk of bleeding, anesthesia reaction, or colon perforation. "What are we accomplishing here?" he asked himself. Five years ago, he might have scheduled it without hesitation. Today, he didn't.
Itzkowitz is part of a quiet revolution in medicine: doctors and researchers are systematically questioning whether common screenings, procedures, and medications truly benefit older adults, or whether the risks have quietly tipped the balance. Recent studies are revealing that some of the most routine interventions—procedures performed hundreds of thousands of times yearly—may cause more harm than good as people age.
Take colonoscopy after 75. Research has shown that repeat screening offers minimal benefit for detecting colon cancer in advanced age, yet the procedure itself carries real dangers. For an 85-year-old on blood thinners, those risks become especially difficult to justify. The same scrutiny is now being applied to other common practices that medicine has long accepted without question.
Dermatologists are reconsidering the near-automatic removal of actinic keratoses—those rough, reddened patches that appear on sun-exposed skin. Dr. Allison Billi, a dermatologist at the University of Michigan, points out that while nearly 30% of Medicare beneficiaries develop these lesions over five years, the threat they pose is minimal. For patients without a history of skin cancer, the risk of progression to actual cancer is less than one in 1,000. The lesions are far more likely to simply disappear on their own. Yet removal is standard practice, typically through cryosurgery, topical creams, or laser therapy—interventions that Billi describes as "extremely painful, both during and after," causing swelling, irritation, and lasting discoloration. "The treatment may be more burdensome than the condition itself," she says. She now advocates for active surveillance instead: annual monitoring by primary care doctors for warning signs like bleeding or rapid growth, with removal only when truly necessary.
Levothyroxine, one of the world's most frequently prescribed drugs, faces similar scrutiny. Doctors prescribe it routinely to older patients with subclinical hypothyroidism—a condition that typically causes no symptoms but might progress to actual thyroid disease. Dr. Jacobijn Gussekloo of Leiden University Medical Center in the Netherlands has found that in many older adults with this condition, hormone levels normalize on their own. More striking: levothyroxine showed "no apparent benefit" and no effect on symptoms in older patients with subclinical hypothyroidism. The drug can interact with other medications that elderly patients take and requires frequent monitoring.
What ties these findings together is a fundamental shift in how medicine approaches aging. For decades, the principle was straightforward: if a screening could detect disease or a drug could address a condition, it should be used. But mounting evidence suggests that in older age, this calculus changes. The benefits that accumulate over 20 or 30 years of treatment disappear when life expectancy shrinks. Side effects and complications that seemed acceptable become the primary concern. "We don't always need to do everything we can do," Billi said—a phrase that captures an emerging consensus: sometimes, doing less is truly doing better.