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Overdiagnosed [Kindle Edition]

H. Gilbert Welch , Lisa Schwartzl , Steve Woloshin
4.8 out of 5 stars  See all reviews (111 customer reviews)

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Book Description

From a nationally recognized expert, an exposé of the worst excesses of our zeal for medical testing

Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening.

Drawing on twenty-five years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with "abnormal" test results have been drastically lowered just when technological advances have allowed us to see more and more "abnormalities," many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10 percent of two thousand healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers.

With genetic and prenatal screening now common, patients are being diagnosed not with disease but with "pre-disease" or for being at "high risk" of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

Editorial Reviews

From Booklist

*Starred Review* Health policy expert Welch’s assertions about the benefits of some of modern medicine’s most popular diagnostic screening tools are unlikely to ingratiate him with many people. He claims that overdiagnosis “is the biggest problem posed by modern medicine,” and backs that assertion up with a barrage of facts, charts, and graphs. This is information, he says, that is downplayed or simply ignored by individuals and groups promoting the notion that earlier diagnosis—whether for prostate cancer or diabetes—translates to better health. Indeed, Welch says, just the converse is more often true. In an overwhelming number of circumstances, early diagnosis turns healthy, asymptomatic people into patients who require a variety of medical interventions with no benefit, even exposing them to unnecessary harm. Worse, overdiagnosis can render perfectly healthy people uninsurable. Furthermore, instead of lowering health-care costs, all those scans, screenings, and tests actually raise costs by overtreating people who will never benefit from said treatment. His point is that both physicians and patients need to be skeptical and understand all the data (pro and con) surrounding prescreening for possible illness. Welch speaks his truth with a frankness and clarity scant found in today’s hysteria over medical prescreening. --Donna Chavez


"Overdiagnosed —albeit controversial—is a provocative, intellectually stimulating work. As such, all who are involved in health care, including physicians, allied health professionals, and all current or future patients, will be well served by reading and giving serious thought to the material presented."─ JAMA

“Everyone should read this book before going to the doctor! Welcome evidence that more testing and treatment is not always better.”─ Susan Love, MD, author of Dr. Susan Love’s Breast Book
“This book makes a compelling case against excessive medical screening and diagnostic testing in asymptomatic people. Its important but underappreciated message is delivered in a highly readable style. I recommend it enthusiastically for everyone.”─ Arnold S. Relman, MD, editor-in-chief emeritus, New England Journal of Medicine, and author of A Second Opinion: Rescuing America’s Health Care
“This stunning book will help you and your loved ones avoid the hazards of too much health care. Within just a few pages, you’ll be recommending it to family and friends, and, hopefully, your local physician. If every medical student read Overdiagnosed, there is little doubt that a safer, healthier world would be the result.”─ Ray Moynihan, conjoint lecturer at the University of Newcastle, visiting editor of the British Medical Journal, and author of Selling Sickness
“An ‘overdiagnosis’ is a label no one wants: it is worrisome, it augurs ‘overtreatment,’ and it has no potential for personal benefit. This elegant book forewarns you. It also teaches you how and why to ask, ‘Do I really need to know this?’ before agreeing to any diagnostic or screening test. A close read is good for your health.”─ Nortin M. Hadler, MD, professor of medi...

Product Details

Customer Reviews

Most Helpful Customer Reviews
139 of 140 people found the following review helpful
5.0 out of 5 stars Good Insights - January 22, 2011
Conventional wisdom is that more diagnosis, especially early diagnosis, means better medical care. Reality, says Dr. Gilbert Welch - author of "Overdiagnosed," is that more diagnosis leads to excessive treatment that can harm patients, make healthy people feel less so and even cause depression, and add to escalating health care costs. In fact, physician Welch believes overdiagnosis is the biggest problem for modern medicine, and relevant to almost all medical conditions. Welch devotes most of his book to documenting his concerns via examples of early diagnosis efforts for hypertension, prostate cancer, breast cancer, etc. that caused patient problems.

Welch provides readers with four important and generalizable points. The first is that, while target guidelines are set by panels of experts, those experts bring with them biases and sometimes even monetary incentives from drug-makers, etc. Over the past decades many target levels have been changed (eg. blood pressure, cholesterol levels, PSA levels), dramatically increasing the number classified as having a particular condition. (Welch adds that prostate cancer can be found at any PSA level - about 8% for those with a PSA level of 1 or less, over 30% for those with a level exceeding 4; most are benign.)

The second is that treating those with eg. severe hypertension benefits those patients much more than treating those with very mild hypertension or 'prehypertension;' the result is treating those with lesser 'symptoms' can easily cause new problems that outweigh the value of the hypertension treatment.

The third is that Welch believes it is usually more important to treat those with disease symptoms (eg. pain) than those without.
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56 of 57 people found the following review helpful
5.0 out of 5 stars Very Important Read January 31, 2011
Format:Hardcover|Verified Purchase
Dr. Welch's book is important and a good read. He explains concepts clearly and thoroughly, and the topic is timely and important for Americans, both from a public health (and personal misery) standpoint, as well as a skyrocketing national medical costs standpoint.

I have worked in the medical field off and on over the years, and even worked on a prostate cancer project, so I already knew a fair bit about the prostate cancer screening/treatment debate. I learned even more from Dr. Welch.

One question that I have had for years, and that has never been answered to my satisfaction is:

If a person is being treated for cancer, and they die from the treatment (on the operating table, from the drugs/radiation, etc.), do they count in the "deaths from cancer" statistic? I personally have known many more people who died from the treatment itself than who died from the cancer, and yet that particular topic does not get addressed. Are death rates from prostate cancer (for instance) holding steady because the treatments don't work, or because men are dying from unnecessary treatment and that offsets the successful treatments? (I did notice that the death rates for prostate cancer went *up* with an increase in detection in the figure on page 56.)

Statistics are smoky, and it really helps to know more about the study design. Dr. Welch does a very good job of describing the various studies, and their flaws and strengths. I'm sure it is a huge hot potato to discuss death rates from treatment, but I would be very interested in seeing those numbers broken out.
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52 of 55 people found the following review helpful
5.0 out of 5 stars Buy one copy for yourself and another for your doctor February 1, 2011
I read Overdiagnosed this morning, and I strongly urge you to read it, too. If you've ever wondered why our country's healthcare costs are skyrocketing even though our health outcomes lag behind the rest of the industrialized world, this book has the answers. We are overtested, overdiagnosed and overtreated. But sadly and paradoxically, this intensive use of "preventive" medicine has not improved our physical health or sense of well being -- it has diminished it.

Dr. Welch builds a strong case that Americans are overdiagnosed in a clear, concise and compelling way. He provides anecdotal accounts of people who were seriously harmed by the overzealous use of modern, high tech testing. And he backs these stories up with findings from landmark medical research studies. As we move from chapter to chapter and disease to disease, we see the same patterns emerge: thresholds for "illness" are lowered and suddenly tens of millions of people are diagnosed and treated for mild or nonexistent "diseases" that never would have harmed them.

Dr. Welch identifies the key players who brought American medicine to this sorry state -- big pharma and medical products manufacturers hungry to increase profits, doctors who order unnecessary tests to avoid malpractice lawsuits, and overzealous patient advocacy groups who press for action in the absence of any scientific evidence of improved outcomes.

Dr. Welch explains key concepts like "lag time bias" and "overtreatment bias" that enable you to see why the benefits of aggressive preventive medicine are far less than you have been led to believe. Once you understand terms like these, you will never again be swayed by misleading advertising or public health campaigns.
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Most Recent Customer Reviews
5.0 out of 5 stars Overddiagnosed
Great book, well written, well researched. I was excited to received it and I would definitely keep it in my library.
Published 3 days ago by Righteously Raw
5.0 out of 5 stars Great book
Too much medicine is practiced by over zealous Doctors treating problems that my never exist. A small spot seen on a MRI and your sent to a surgeon to extract although the risks... Read more
Published 3 days ago by Duane Snyder
5.0 out of 5 stars Excellent book!
I love that this book was written by practicing, "normal" doctors. There is no "alternative medicine" feel, which I think makes it more valuable and apt to be taken... Read more
Published 14 days ago by Fiddle Chick
5.0 out of 5 stars Book addresses problems with modern medicine.
Book was well-written and addressed my concern. So many books and articles deal only with the monetary aspects of American medicine. That 's been overdone.
Published 25 days ago by carol h. dedov
5.0 out of 5 stars Definitely worth reading!
I am very cautious about this type of book, since so many are written by hucksters just trying to inflame your thinking or sell you something.
However, In this case, Dr. Read more
Published 1 month ago by Mac
5.0 out of 5 stars Let sleeping "bugs" lie
Fifteen years ago I had a bad auto accident resulting in a smashed acetabulum and consequent multiple hip replacement surgeries. Read more
Published 1 month ago by Ajay Mehrotra
5.0 out of 5 stars eye-awakening
Going through the gamut of a spectrum of medical conditions, the physician author provides chapter after chapter of warnings (statistical and case historical) about the dangers of... Read more
Published 1 month ago by Davey Jay
5.0 out of 5 stars Just Read it!
Overdiagnosing and overtreatment is not only a problem in America. Being a medical doctor in Denmark a meet it every day.
Published 1 month ago by Thomas Birk Kristiansen
4.0 out of 5 stars Overdiagnosed -- good information
This medical doctor really understands his mathematical analysis. This is rare. It's a Worthwhile book. There is a lot about cancer diagnosis and evaluation.
Published 1 month ago by juno
5.0 out of 5 stars To Do No Harm?
It is rare for a book to make me angry. However, Over-Diagnosed by Dr. H. Gilbert Welch did just that. Read more
Published 2 months ago by C.R. Hurst
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More About the Author

Dr. H. Gilbert Welch is a nationally recognized expert on the effects of medical screening who has appeared on The Today Show, CNN, NPR, and in the New York Times and Washington Post. He and the coauthors of Overdiagnosed, Dr. Lisa M. Schwartz and Dr. Steven Woloshin--nationally recognized experts in risk communication--are professors at the Dartmouth Institute for Health Policy and Clinical Practice.


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