Matter of opinion, preference, and what's worked in someone's personal experience. Most of us, myself included, have only a sketchy knowledge of fish meds and their biology and effects. Very few of us are anything approaching experts. For example, how many know which common meds are less effective or not effective in African cichlid (or medium to hard water) conditions because they react with calcium in the water, reducing their effectiveness?
But I'll put it this way. When you're sick, chances are the first thing you'll try is rest or some form of home care or home remedy or over the counter remedy and hope that's enough. But if you stay sick or get worse or whatever it is seems to be serious you probably go to a professional and accept some form of medication.
I approach fish that way. Something mild I treat without meds, even ich. But if it persists or worsens or looks like something serious I'm not going to fool around while my fish suffers or goes downhill. Many, maybe most, fish meds, used properly and not overused or overdosed are not going to do any long term damage to your fish or shorten their lives. I know this from research and personal experience. You have to consider, which will be more damaging to your fish, allowing an illness or pathogen to continue to damage your fish if a milder form of treatment isn't working or stepping in with medication?
Had my first case of ich in probably 20 years last summer, result of a 10 day power outage after the derecho storm we had and having to keep my fish alive without power by doing water changes out of a nearby river. Afterward I had ich, bad in one tank, no doubt introduced with the river water. Tried heat and salt and it was only getting worse. So I went to Coppersafe, fish still looking bad. Added daily doses of Aquari-sol (the whole point being to get the total levels of copper high enough) and saw substantial results within days, kept up Aquari-sol for another week, left salt and heat and Coppersafe as is for another couple of weeks and never saw a hint of it again. Fish are good ever since, spawning, growing, etc. etc.
Mild case of ich is one thing, but bad case of ich can cause gill and tissue damage, result in secondary bacterial or fungal infection, or even kill a fish. If heat and salt are working, great, stick with it. But if not you don't want to fool around imo.