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Die Diagnosefalle: Wie Gesunde Zu Kranken Erklärt Werden (German Edition) (2013)

by H. Gilbert Welch(Favorite Author)

4.16 of 5 Votes: 2

languge

English

genre

Nonfiction

publisher

Riva

review 1: Would explain a lot about why we spend so much on medical care yet do not have the best health in the world. The author reviews several diseases (mainly cancers) and asks whether they are being overdiagnosed. The principal hypotheses the author makes behind his analysis are:- Doctors have never really operated in a scientific manner. Since they often do not have the luxury of denying patients treatment and seeing whether they get better anyway, they never really know whether treatment was effective. However, they probably think the treatment was effective simply because they may have developed the treatment (and are inclined to think it should work), or through a simple confirmation bias. The gold standard for figuring out the effectiveness is a randomized trial, where you... more can see if there is a difference in outcome between the treated group and a control group. Randomized trials, and long-term studies of patients who underwent treatments (such as surgeries) have often shown that treatments once thought to be revolutionary actually had no effect, or even a negative effect. However, at the time when they were developed, they were widely adopted because there was no thought to even try and measure their effectiveness.- More and more, doctors are using some numerical score (such as PSA) to determine whether a patient should undergo further screening. However, the thresholds for these tests are set more or less arbitrarily. The main effect of lowering the threshold is often that doctors will rely solely on these scores, even in the absence of the traditional symptoms of the illness. The problem is that as you lower the “safe” thresholds for these scores, the ratio of false positives over actual positive detections increases, and you end up diagnosing many more healthy people.- Doctors are relying more and more on imaging scans to “detect” abnormalities. However, the problem is that it is normal to have abnormalities, and now that we can see those abnormalities many people are afraid to leave them untreated, even though they may be perfectly normal anyway. There are several anecdotal cases in the book where the person went in for one minor problem, and several scans and doctors later, were recommended for drastic, quality-of-life affecting treatments, often which there inappropriate given that the patient had no symptoms other than an abnormal imaging scan.I think the most compelling evidence presented that would show the author is right are graphs showing the number of diagnoses vs the number of deaths. If doctors were correctly diagnosing more patients, you would expect the number of deaths to increase at the same or similar rate. However, the graphs show that while diagnoses have skyrocketed, the number of deaths has remained virtually flat. Opponents may argue that the number of deaths remains flat because of improvements in treatment, but that argument doesn’t really hold water because it’s highly unlikely that the rate of improvements in treatment would track the increase in diagnoses so closely. Also, in one of the cases, where doctors were cognizant of the fact that a particular disease was being overdiagnosed, and purposely stopped diagnosing it so much, the number of deaths still remained flat.The main moral takeaway of the book is that both doctors and patients typically only consider the risk of missing a positive diagnosis, and ignore all the costs of a false diagnosis. There are not only financial costs involved with excessive scanning and diagnosing, but there are also health considerations involved. There is mental anguish in wondering whether one will die of cancer. Prostate biopsies and operations often result in impotence. Today’s medical industry has somehow become obsessed around secondary metrics, like number of diagnosis, rather than lives saved. This leads to situations like we have now with some cancers, that the treatment often has zero net benefit (the patient will not live significantly longer) while also resulting in a decreased quality of life (side effects of treatment).
review 2: Dr. Welch makes the unusual suggestion that current methods of screening for disease as a means of prevention often results in over-diagnosis. Expensive tests are ordered, abnormalities are discovered, patients are unnecessarily traumatized in the name of disease discovery. He suggests that not all tests and screenings are necessary, and that there is evidence to show that they can do more harm than good. Convincing examples of data and patient histories are shared. Unfortunately, the predominant medical culture (doctors, drug companies, patients, etc.) subscribes to the notion that any abnormalities must be examined, explored, and rooted out before they have a chance to do any damage. Changing the mind of that culture is going to be an uphill battle, which the authors of this book acknowledge. If you’ve ever wondered if a test or a screening that your doctor ordered was strictly necessary, you may be interested in reading “Over-Diagnosed.” You may even decide to forgo a test or screening in the future in the interest of preserving your health. Fascinating read, but will not necessarily help you make a choice regarding your own healthcare. At least you will know that you have options and that you should weigh them carefully before proceeding. less

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