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Overdiagnosed: Making People Sick In The Pursuit Of Health (2000)

by H. Gilbert Welch(Favorite Author)

4.16 of 5 Votes: 2

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English

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review 1: Dr. Welch sheds light upon a controversial, lesser-known corner of medicine -- over-diagnoses. Although it is a term rarely used in today's medical world, he (and others) are bringing up issues in the U.S. healthcare system of how not everything that we pursue in medicine may be beneficial to the patients, physicians, and the system as a whole. Today's medicine is all about catching diseases early, even before it starts. and testing and treating more. This can bring more income, prevent malpractice, and bring assurance, albeit many times after first causing the anxiety. So here's where over-diagnosis comes into play.He focuses in many specialties in medicine, such as over-treating mild diabetes and hypertension, screening harder for cancers, especially prostate and breast ... morecancers, and acting upon predispositions in our genes. He argues that certain mild diseases that may not cause symptoms (but are passed the arbitrary threshold) such a pre-diabetes or very mild hypertension, might be better left alone, to save the patient some anxiety and inconvenience. As for the cancer screening, he counters the "early-diagnoses" dogma with the psycho-emotional stress this may bring to the patients if they hear of it and pursue early treatment that may not have been needed. A few concepts he brings up multiple times are lead-time bias which makes it seem like people are living longer after a diagnosis which they may not even die from with early detection and treatment, weighing the benefits and risks, and treating symptomatic diseases, instead of pre-symptomatic diseases which may never manifest to harm the patient. Of course, if there are symptoms, treat it! But his stance is if it is not symptomatic and may never be, why treat it and cause unnecessary side-effects to the patient?He makes a very compelling argument, which many physicians oppose. He utilizes very elementary statistics, which makes his arguments very easy to understand, oftentimes comparing the numbers of how many people will benefit from screening and early treatment compared to how many will get early treatment and not benefit. His writing is very straight-forward and he avoids needless jargon which makes this book perfect for anyone looking for different perspectives on healthcare. I would definitely recommend this book to future healthcare workers and to those who may be anxious about their health.Note: if you are high-risk for a certain disease, please do have a qualified physician follow-up with you. However, it's up to you how/if you want to be treated!
review 2: We know too much! The author, a physician and researcher, discusses the problems of overdiagnosis, including the controversial mammogram overdiagnosis issue and others. He suggests that much of the testing we do is unnecessary and even counter-productive in terms of patient health. He explores with depth and compassion, the issues with the literally millions of folks who suffer under 'false positive' diagnoses, from blood pressure, to cancer to childbirth, which he finds has been medicalized to an alarming degree.Agree with his position or not, he provides enough engaging case material to make this a lively and important read. I think he dumbed down some of the statistical underpinnings to reach a larger audience and I can't really blame him, but I could have wished he'd incorporated just a bit more data in-line with the book.Moral issues discussed include: "We missed one!" (doctors are often liable for under-diagnosis, yet not so for over-diagnosis); "Somebody might die" (doctors and people have an entirely understandable horror of "missing something" and letting a patient die who might have been saved, but less horror of over diagnosing tens of thousands of patients, many of whom suffer - patients operated on w/o real need, patients suffering through the mental anguish of thinking they *may* have something, physicians and powerful academic committees that are influenced heavily by what I call the "medical-industrial complex". less

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