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Overdiagnosed: Making People Sick in the Pursuit of Health Hardcover – January 18, 2011

4.6 4.6 out of 5 stars 597 ratings

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From a nationally recognized expert, an exposé of the worst excesses of our zeal for medical testing
 
After the criteria used to define osteoporosis were altered, seven million American women were turned into patients—literally overnight. The proliferation of fetal monitoring in the 1970s was associated with a 66 percent increase in the number of women told they needed emergency C-sections, but it did not affect how often babies needed intensive care—or the frequency of infant death. The introduction of prostate cancer screening resulted in over a million additional American men being told they have prostate cancer, and while studies disagree on the question of whether a few have been helped—there’s no disagreement that most have been treated for a disease that was never going to bother them. As a society consumed by technological advances and scientific breakthroughs, we have narrowed the definition of normal and increasingly are turning more and more people into patients. Diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades, while the number of deaths from those diseases has been largely unaffected.
 
Drawing on twenty-five years of medical practice and research, Dr. H. Gilbert Welch and his colleagues, Dr. Lisa M. Schwartz and Dr. Steven Woloshin, have studied the effects of screenings and presumed preventative measures for disease and “pre-disease.” Welch argues that while many Americans believe that more diagnosis is always better, the medical, social, and economic ramifications of unnecessary diagnoses are in fact seriously detrimental. Unnecessary surgeries, medication side effects, debilitating anxiety, and the overwhelming price tag on health care are only a few of the potential harms of overdiagnosis.
 
Through the stories of his patients and colleagues, and drawing from popular media, Dr. Welch illustrates how overdiagnosis occurs and the pitfalls of routine tests in healthy individuals. We are introduced to patients such as Michael, who had a slight pain in his back. Despite soon feeling fine, a questionable abnormal chest X-ray led to a sophisticated scan that detected a tiny clot in his lung. Because it could not be explained, his doctors suggested that it could be a sign of cancer. Michael did not have cancer, but he now sees a psychiatrist to deal with his anxiety about cancer.
 
According to Dr. Welch, a complex web of factors has created the phenomenon of overdiagnosis: the popular media promotes fear of disease and perpetuates the myth that early, aggressive treatment is always best; in an attempt to avoid lawsuits, doctors have begun to leave no test undone, no abnormality—no matter how incidental—overlooked; and, inevitably, profits are being made from screenings, a wide array of medical procedures, and, of course, pharmaceuticals. Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.
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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

Review

"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 medicine and microbiology/immunology at University of North Carolina at Chapel Hill and author of
Worried Sick and The Last Well Person
 
“We’ve all been made to believe that it is always in people’s best interest to try to detect health problems as early as possible. Dr. Welch explains, with gripping examples and ample evidence, how those who have been overdiagnosed cannot benefit from treatment; they can only be harmed. I hope this book will trigger a paradigm shift in the medical establishment’s thinking.” —Sidney Wolfe, MD, author of
Worst Pills, Best Pills and editor of WorstPills.org

Product details

  • Publisher ‏ : ‎ Beacon Press; 1st edition (January 18, 2011)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 248 pages
  • ISBN-10 ‏ : ‎ 0807022004
  • ISBN-13 ‏ : ‎ 978-0807022009
  • Item Weight ‏ : ‎ 1.1 pounds
  • Dimensions ‏ : ‎ 6.24 x 0.94 x 9.3 inches
  • Customer Reviews:
    4.6 4.6 out of 5 stars 597 ratings

About the author

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H. Gilbert Welch
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Dr. H. Gilbert Welch is an internist at Brigham and Women's Hospital - Center for Surgery and Public Health (go figure), and a nationally recognized expert on the effects of medical testing. He has been published by the Los Angeles Times, New York Times, Washington Post, and Wall Street Journal, as well as major medical journals, and he has appeared on network television, CNN, and NPR. Dr. Welch is the author of three books, Less Medicine, More Health; Should I Be Tested for Cancer?; and the highly acclaimed Overdiagnosed.

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4.6 out of 5 stars
597 global ratings

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Customers say

Customers find the book's information clear and thorough. They appreciate the author's views and consider it a thoughtful, careful analysis of the impact of the flood. The book is described as an easy read that can be understood by a layperson. However, opinions differ on the health implications, with some finding it a great corrective to over-testing in medicine and making a convincing case for less medical testing, while others mention potential harms of overdiagnosis and treatment.

AI-generated from the text of customer reviews

118 customers mention "Information quality"112 positive6 negative

Customers find the book provides clear and thorough explanations of concepts. They appreciate the author's views and thoughtful analysis of the impact of the flood. The book provides important information on the limits of modern medicine and introduces healthy skepticism about all the things we may consider. It is pertinent for any user or health provider.

"...It is a large dose of sanity in the face of all the pressure from doctors, advocacy groups for various diseases, public service ads and commercials..." Read more

"...He explains it so clearly that I think my 5-year-old grandson could understand it. His writing style is engaging and holds your interest...." Read more

"...He also presents a balanced view of the real risks that go both ways. He doesn't sugarcoat the risk that can come from deadly diseases like cancer...." Read more

"...medicine, using lot of data, their own thinking and experience as medical doctors. They presented their argument from all angles they can find...." Read more

104 customers mention "Readability"104 positive0 negative

Customers find the book readable and engaging. They appreciate the well-reasoned arguments and consider it an important and brilliant work.

"...This book is very well-written, with clear explanations, nice graphs to help illustrate the points made, and plenty of eye-popping examples...." Read more

"...too many case histories, but the ones he does have are all went worth reading about...." Read more

"...This is a great book to get a balance view from a doctor who practices traditional, conservative Western medicine and who has been a researcher with..." Read more

"...Excellent work...." Read more

35 customers mention "Ease of reading"28 positive7 negative

Customers find the book easy to read and understand. They appreciate the clear writing style, accessible format, and simple statistics. However, some readers mention that it's not a quick read due to its content.

"...The procedure was fast and not too unpleasant, but I was surprised to get a phone call a few days later telling me I needed to make another..." Read more

"...I found the book a quick and easy read. It was written clearly in terms perfectly understandable to the layman...." Read more

"...days this was a real issue and the CAT scan allowed for a rapid and accurate determination and helped save lives. Then its use expanded...." Read more

"The authors have created a very clear, readable and convincing book that deals with the medical field's definition of `disease'...." Read more

7 customers mention "Health implications"4 positive3 negative

Customers have different views on the health implications of the book. Some find it a great corrective to over-testing in medicine and makes a convincing case for less medical testing. It changes their views on screening, especially cancer screening. Others mention the potential harms of overdiagnosis and treatment, as well as side effects from drugs and surgeries.

"...It has changed my views on all screening, but especially cancer screening." Read more

"...This book illustrates the potential harms of medical testing, and the potential harms of over diagnosis and treatment...." Read more

"...; The information in this book will give you a very different perspective on various tests and "diagnoses" promulgated by many in the..." Read more

"...when you have symptoms but points out the awful side effects of treating diseases without symptoms. My great-uncle lived to be 94 years old...." Read more

An indictment to modern medicine
5 out of 5 stars
An indictment to modern medicine
This important book can be read both as an indictment to modern medicine and as a critique to the medicalization of life in general and to the paradigm of “early diagnosis” in particular. According to Dr. Welch, thousands and thousands of healthy individuals are being turned into anxious patients, with dire consequences upon their health and their finances.The main argument of the book can be summarized in a single figure (see below). “New diagnoses” are increasing steadily, but “deaths” are flat. These combined trends show up in a whole range of diseases: prostate cancer, breast cancer, lung cancer, diabetes, hypertension, osteoporosis, and so on. In all these cases more people are being diagnosed, but the increase in diagnosis has not been followed by a decrease in mortality, contradicting the purported advantages of “early diagnosis”. In short, more people are being diagnosed and treated, but no more lives are being saved.Overdiagnosis is creating unnecessary anxiety, unnecessary hassles and unnecessary suffering. According to Dr. Welch, various factors contribute to the epidemic of overdiagnosis. Most decision makers profit from the frenzy of tests and screening. Also, hard evidence (i.e., randomized trails) on the impact of screening and preventive medication is scant to say the least. Finally, several cognitive biases reinforce the paradigm of early diagnosis.This is not an optimist book. Dr. Welch convincingly argues that the problem in question constitutes a dominant paradigm, a stable and perverse equilibrium, and that overdiagnosis begets overdiagnosis. Overturning this sorry states of affairs will be difficult, if not impossible. Many things will have to change. This book, for example, should be required reading for physicians, pundits and politicians. Overdiagnosis is not the way to pursue health, Dr. Welch argues elocuently. We should pay attention to his warnings. There are many lives at risk and much money wasted enriching the peddlers of fear and medical stuff.
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Top reviews from the United States

  • Reviewed in the United States on June 6, 2012
    This book will probably appeal to people like me, who have already been questioning the value of endless screening tests, but I hope others will read it as well. It is a large dose of sanity in the face of all the pressure from doctors, advocacy groups for various diseases, public service ads and commercials from companies offering screening tests who tell us we need to be screened because "early detection saves lives." Usually they throw in some stories of people who got screened, got treated and are still alive. They are all quoted saying "Early detection saved my life."

    But did it? Or did it just turn them into patients years before their "disease" would have manifested itself? Worse yet, maybe that tiny growth detected on the X-ray would NEVER have turned into actual disease. In that case, they did not need any treatment and may have been harmed by the treatment they received. Dr. Welch calls this "overdiagnosis."

    Dr. Welch points out that these "success" stories lead to more screening which leads to more useless treatment. Proponents often cite the increased "cure" rate of those who are screened versus those who are not. Logically, the time between diagnosis and the time when the patient is considered "cured" (say, five years with no recurrence) will be greater if a tumor was found several years before it would have manifested as symptoms. With or without screening, a tumor would grow (or not grow) at the same rate. Without screening, a tumor that grows will be discovered when the patient has symptoms. That's a later diagnosis, but the course of the disease is the same and early treatment might make no difference at all.

    MY MAMMOGRAM STORY
    I am in my middle 60s and had always resisted getting a mammogram until recently. I had changed doctors and my new doctor gave me a referral and I decided to do it this time. I think it was mostly out of curiosity and because Medicare would pay for it (a wrong reason, I know!). The screening was done at a huge hospital complex (Beaumont Hospital in Royal Oak Michigan). The procedure was fast and not too unpleasant, but I was surprised to get a phone call a few days later telling me I needed to make another appointment for more views. I asked why and got no real answer, other than the Radiologist wants more views. I said I needed more information before I would come back and they said to call my doctor. I did that, and his staff person had to search for any information about my mammogram, but finally found what the hospital had sent and it merely said that the results were inconclusive for the left breast. This does not tell me what was inconclusive. I then received a letter from the hospital, which said the initial findings showed "a need for additional imaging studies, such as additional mammographic views, ultrasound or MRI for a complete evaluation." This sounded to me like the start of a cascade of expensive and possibly invasive and dangerous services which I did not want. I got several more calls from the hospital urging me to make another appointment, but I was not satisfied with the lack of real information as to why I should do that. Finally another woman called me who would only say she was "Sharon," so I don't know her position, but she must have been a supervisor because she did tell me more (there was an "asymmetrical density " in the left breast), but would not name the Radiologist (I later got her name from my Medicare payment info online). Sharon said (in effect) I was likely called back because this was my first and only mammogram and they had nothing to compare it with. I subsequently received a certified letter from the hospital, which I take to be their "CYA" letter in case I turn up with cancer and sue them. I finally sent them my own certified letter explaining why I was not returning and asking for access to the images and notes from my mammogram. They have never responded.

    I do breast self-exam and there are no lumps or any abnormality. I have no symptoms and I feel fine. I am more willing to trust my own instincts that I do not have brest cancer than I am willing to trust the people at the hospital. My only regret is getting the mammogram in the first place.

    To hear all the hype about mammograms, you'd think they somehow PREVENTED cancer, whereas they do no such thing. They are X-rays of the breast and the "findings" are the opinion of a Radiologist who does not see you or examine you. I find Radiology a strange kind of medical specialty. It does not involve patient contact, but is based on a person (presumably the Radiologist) studying images and coming to a conclusion. In the book, Dr. Welch has a horrific story of a pregnant lady whose imaging screening could not image one of her baby's feet. The Radiologist decided the baby probably had a club foot. The poor mother-to-be drove herself crazy learning all about club feet and imagining what life would be like for her deformed child. When the baby was born, both feet were perfect. The point is, these images are often going to find anomalies that can't be definitively said to be deformity or disease. But the findings WILL lead to a lot more medical services.

    I think Dr. Welch actually underestimates one of the consequences of this and that is the expense. Whether it's the patient paying (increasingly the case) or insurance or Medicare, screening leads to a lot of expensive services that are not needed and can do a lot of harm. Men treated for early signs of prostate cancer can become permanently impotent, and the worst of it is their prostate cancer may never have progressed to a point where they would have symptoms. Many men with prostate cancer eventually die of something else because the cancer is so slow growing, or may not grow at all. Particularly with prostate and breast cancers, studies involving autopsies show many people have small cancers they never knew they had and which never caused any symptoms.

    Dr. Welch works for the VA, which is a single-payer government-funded system in which the doctors have no financial incentive for overtreating patients, but I think lots of doctors are biased in favor of treatment when it may not be needed because of the extra income it brings. Radiologists who don't even see the patient have every incentive to say they "need more views." The hospital has every incentive to encourage women to come for mammograms, then to do more imaging if anything at all is found on the screening X-rays.

    Dr. Welch also barely mentions the fact that X-rays CAUSE cancer! Yes, we've all heard about how tiny and harmless those doses are in a mammogram or other X-ray, but the effect is cumulative. That is one reason I was not eager to "have more views" taken. When those dose amounts in a mammogram are mentioned, how many "views" are they based on? Why don't screening services release actual information of the dosage of each view? How do I know their machines are working properly or that their technicians are competent? Why should I trust these medical providers on this subject when they have so much incentive to encourage "more views?"

    Too much worrying about our health and visiting doctors when we are not sick is adding to our bloated health care bill in the US. Maybe we should just accept our own mortality and not seek ever-more information from inside our bodies via screening. People talk about the supposed benefit of finding disease early, but never about the harm of pursuing tiny ambiguous anomalies leading to treatment that could be unnecessary and surely is expensive.

    This book is very well-written, with clear explanations, nice graphs to help illustrate the points made, and plenty of eye-popping examples. Before you buy in to "early diagnosis" and give into the pressure to get screened, read this book and use your head. Dr. Welch makes his case.
    88 people found this helpful
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  • Reviewed in the United States on June 9, 2015
    I've always felt a bit like an outlier in the current medical environment in the US, meaning that I've always done my best to avoid doctors at all costs. It's good to know they are there if I should break a leg, but prefer to leave them alone otherwise. In my 20s this was easy. It became less so in my 30s when I fell jumping over a fence and suffered a serious knee injury (shredded posterior cruciate ligament) that forced me into seeing doctors, and having surgery and lots of physical therapy. But the outcome was good and I still use that knee today, 30 years later. :-)

    Then in my 40s I had an issue that forced me to see doctors again. It started innocently enough, mild nausea after eating. But it grew until I was nauseous after just about every meal, much intestinal distress also. I began throwing up on pretty much a daily basis, and finally began my series of doctors visits - and tests including abdominal X-rays, abdominal CAT scan, endoscopy, GI series .... and amazingly enough (especially after reading Dr. Welch's book) they found NOTHING wrong with me! I was throwing up my lunch every single day but I was in perfect health as far as all the tests went! The top-rated gastroenterologist I was sent to prescribed Prilosec and that seemed to help, so he basically said "No clue what is wrong since your tests are all normal, but since this helps I guess you will just be on Prilosec for life".

    That was NOT the answer I wanted since my goal is to be on NO meds if possible, or as few as I can manage. I didn't want a "for life" pill when I was only in my 40s, for a condition of unknown cause. It was a *neighbor*, whose daughter had recently been diagnosed as celiac, who suggested to me that I try avoiding wheat for a week or two. That was actually hard to do since wheat is so ubiquitous that it's in virtually everything, but it was easier than facing a lifetime of drugs. I gave it a try and in *ONE WEEK* all my symptoms vanished! No more nausea, no more GERD, no more vomiting, no more intestinal distress. Even symptoms that I though were completely unrelated (my stiff achiness when I woke up in the morning) went away! And never to return as long as I avoid wheat - but no doctor ever suggested it.

    I was later lucky to find a doctor whose attitude was fairly laissez-faire about medical treatment, didn't push the government line, was in favor of trying alternative methods like diet and exercise before turning to the prescription pad... but then I moved 1000 miles away so could hardly continue to see her.

    So for four years in my new location I had no doctor, just the way I like it. But I'm not getting younger and had a few sicknesses this winter, was in a somewhat serious auto accident, so decided I should be on *someone's* books just in case I had a serious problem and needed help. I went for a GYN appt first, and got coerced into a mammogram and a bone density exam - something I had never done as saw no point to it. If they don't like the density of your bones the only thing they will do is prescribe a bisphosphonate which I would never take anyway (and Dr. Welch backs that up).

    Sure enough, they found "osteopenia" in one hip and without even consulting me just TOLD me they had prescribed the bisphosphonate and I needed to start taking it immediately. They had already called in the prescription to my pharmacy.

    Luckily I think I've struck gold with my new primary care doctor however. I saw her for the first time the next week and told her the story. She was totally in agreement with me and told me not to fill the prescription: "way too many bad side affects for almost no benefit" was how she put it. told me to try some weight-bearing exercises, eat calcium-rich foods, and make sure I got enough vitamin D. She is not another pill pusher by any means.

    I don;t want to end up like my dad who was on about 20 different prescription meds by the end of his life, many with bad side affects, some drugs to combat the side affects of other drugs... He was prescribed a statin and blood pressure pills for NO GOOD REASON - 75 years old and a strong heart and a blood pressure of 110/65, but his cholesterol was "mildly" elevated (about 220) so the doctor said he needed both, and my sister and I are convinced that that was what ultimately led to his death. He lived for 6 more years but within months of going on the statins (which we were clueless about at that time) and BP meds he went from a strong vigorous 75-year-old to one who was hunched over, frail, constantly falling (as his BP would drop to something like 80/40 on the meds, causing him to faint), developed congestive heart failure (a known side affect of statins). My sister did some research and finally got his doctor to take him off the statins and BP meds - my dad was of the old school who did exactly what the doctor said and would never have dreamed of saying NO to any recommended med, or stopping one on his own. He did improve a bit after going off those drugs, but never really regained his health, and it was just a downward spiral from there over the next five years.

    So I'm totally on-board with Dr. Welch's "less is more" philosophy. I found the book a quick and easy read. It was written clearly in terms perfectly understandable to the layman. One needn't have training in medicine or statistical analysis to understand the points Dr. Welch is trying to make. He explains it so clearly that I think my 5-year-old grandson could understand it. His writing style is engaging and holds your interest. He doesn't have too many case histories, but the ones he does have are all went worth reading about. I would recommend this book to anyone, but I think it truly needs to be REQUIRED reading as part of every medical school curriculum in this country,
    37 people found this helpful
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Top reviews from other countries

  • Eduardo Cruz
    5.0 out of 5 stars Frightening
    Reviewed in Brazil on January 19, 2023
    The book shows how image scans and other health tests may create healthy patients with the sole purpose of making money. PSA low limits will induce unnecessary prostate biopsies, excess RMI may lead to useless and risky surgeries. A must read for doctors and patients as well.
  • Thierry Landrieu
    5.0 out of 5 stars Brillant
    Reviewed in France on June 20, 2021
    The subject is much more complex than I thought . But the author doesn't hesitate to come back at length to reinforce or understanding , and while it could feel tiresome , it is in fact necessary to understand the self-reinforcing nature of overdiagnosis .
    Very good and intelligent book , but hard to summarize . Because ..... The subject is rather counter-intuitive .
    Reading it 10 years after publication, it allowed me to understand a bit better our new covid era , were you are deemed to be sick after a pcr test , even if you feel perfectly fine - while in fact you just may be potentialy contagious ( which is enough to incite you to stay at home )
  • Amazon Customer
    4.0 out of 5 stars Four Stars
    Reviewed in India on September 8, 2017
    An honest book on medical practice
  • Amazon Customer
    5.0 out of 5 stars Very easy to read
    Reviewed in the United Kingdom on January 8, 2017
    Very easy to read, excellent points about the harms of over diagnosis and over treatment. A bit Americanized but lays out the evidence very clearly. A must read for primary care doctors.
  • Daniela C.
    5.0 out of 5 stars VGR
    Reviewed in Italy on October 2, 2015
    Very good read. Lots of info I'd never tapped into. I advised it to many friends and lent it, too.