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Overdiagnosed: Making People Sick in the Pursuit of Health Hardcover – January 18, 2011
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*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 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
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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,
Who reads this review? Does the author?? I hope he does. I am not a statistic, so I think his info is more for statistical studies.But if I AM a statistic, I think they count me AFTER I have developed something. I really don't care what percent I am. For what happens to me, that is 100% for me.
There are NUMEROUS doctors who are starting to explain why this test or that test is not as relevant as some of the newer tests - for example, instead of cholesterol screening, tests for inflammation are FAR more useful. Well... sort of... I'll explain that in a minute. Yet we continue to hear so many people talk about cholesterol levels and statin drugs being prescribed for "normal" blood cholesterol levels to push them even further lower. Why? Corporate Pharmaceutical GREED. There is rarely value in further lowering cholesterol levels and quite frankly now the research is showing good cholesterol is far more important. Furthermore, the real problem with cardiovascular disease is a combination of nutrient deficiencies, too much stress and too much inflammation. Resolve those 3 pillars to greatly reduce the risks associated with cardiovascular illnesses. I PROMISE. What are my credentials? I do NOT have conventional medical training. Instead I am experienced caring for a loved one who once suffered from end stage CHF and was given a prognosis of mere days when he was sent home - to die. Instead, he decided he wanted to live so we began a great undertaking to empower ourselves. At the time I post this review nearly 7 full years has passed and he's still alive to tell his story.
There are many other reasons I can relate, but I don't want to keep you from getting into this book. Please, get a copy whether you borrow it or buy it and READ THIS BOOK. It's THAT critical to understand the problem. Dr. Welch is soon to release another book, Less Medicine, More Health which appears to be very promising, as well.
Note: I have absolutely no affiliation to Dr. Welch or anyone involved in this publishing of this or any of his other books. I am an avid book reviewer who has experienced the absolute worst of the healthcare industry (such as watching an ER team "accidentally" causing my husband to experience death before resuscitating him, watching as an ICU team performed an emergency tracheostomy on my father as he was dieing of liver failure that I'm absolutely certain was attributed to his prescription statin medications (despite routine labs every 3 months his doctor never indicated there was anything to be concerned about yet one morning he awoke very sick and in the final stages of liver disease - trust me it's a horrible horrible horrible way to go!), and watching both my biological mother then decades later my step-mother being misled, misdiagnosed, medically abused, outright lied to and mistreated by medical professionals as they lost their lives at the hands of the Medical Empire. I'm tired of us being treated as human guinea pigs - usually without our knowledge nor our INFORMED consent and I feel it's time we empowered ourselves over our own health.