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on April 3, 2014
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 seriously by people with the mindset of "traditional Western medicine" = "the only REAL medicine". I don't fall into that category, but I think books like this are desperately needed and should be in the hands of every single human in the industrialized world. There is a lot of eye-opening information that will save many people a great deal of time, worry, and stress. If you have a body READ THIS BOOK!!
on February 4, 2013
This is an excellent book. In a sense, it shows you the ways in which your doctor may be "over-utilizing" your health plan.
With higher patient deductibles and copays - it costs YOU, the patient, more money because you have to pay for all the tests your doctor wants to use, to over-diagnose you.
Watch out for receptionists and nurses using terms like, "the doctor needs to see you in 6 months."
No one knows if you will be ILL in 6 months, so if there isn't something CURRENTLY wrong, which is "unstable" -- where does the doctor get this idea he "needs" to see you in 6 months? You get better value for your money, if you wait til YOU are the one needing to see the doctor, not vice versa.
It should be the PATIENT who is determining when HE (the patient) needs to see the doctor. Suggest to the receptionist that YOU will call and make an appointment, when YOU need to see the doctor; not vice versa.
And by reading this book, you will come away with a knowledge of the ways in which doctors increase the cost of medical care, using the cover of "preventative medicine."
This book gives patients the information they need, to start MANAGING their doctors, and MANAGING how high their medical expenses go ! Learn what tests you would be better off saying "NO" to; and, know why you are saying NO to all those tests.
Be wary of doctors who have sold their practices to hospitals, and are working in the clinics -- they are great at "over-referring" patients. If you want expensive medical care -- just start seeing a doctor who has left private practice for a hospital-based practise.
Enjoy the read. Did you happen to notice -- the author of the book has an excellent set of credentials to be writing about this topic !!
With higher patient deductibles and copays - it costs YOU, the patient, more money because you have to pay for all the tests your doctor wants to use, to over-diagnose you.
Watch out for receptionists and nurses using terms like, "the doctor needs to see you in 6 months."
No one knows if you will be ILL in 6 months, so if there isn't something CURRENTLY wrong, which is "unstable" -- where does the doctor get this idea he "needs" to see you in 6 months? You get better value for your money, if you wait til YOU are the one needing to see the doctor, not vice versa.
It should be the PATIENT who is determining when HE (the patient) needs to see the doctor. Suggest to the receptionist that YOU will call and make an appointment, when YOU need to see the doctor; not vice versa.
And by reading this book, you will come away with a knowledge of the ways in which doctors increase the cost of medical care, using the cover of "preventative medicine."
This book gives patients the information they need, to start MANAGING their doctors, and MANAGING how high their medical expenses go ! Learn what tests you would be better off saying "NO" to; and, know why you are saying NO to all those tests.
Be wary of doctors who have sold their practices to hospitals, and are working in the clinics -- they are great at "over-referring" patients. If you want expensive medical care -- just start seeing a doctor who has left private practice for a hospital-based practise.
Enjoy the read. Did you happen to notice -- the author of the book has an excellent set of credentials to be writing about this topic !!
on February 28, 2015
I absolutely LOVED this book! Reading it has strengthened my resolve to step back and tune out the noise. I have been on the "medical merry-go-round" a few times myself and I wish I knew then what I know now. It is empowering to get an insiders' view of what is actually going on behind the curtain. An important book to keep on hand (to refresh your memory from time to time). And especially when you are confronted with medical decisions in the future. I hope everyone understands the true value of this book and takes it to heart. Thank you Dr. Welch. I hope your message spreads across the globe...
on April 25, 2013
I think everyone would benefit immensely from reading this book. It gives very important information on the limits of what modern medicine can actually do in the area of "preventive medicine" and how it has been grossly "oversold" out of both honest zeal and financial incentives. He also goes into detail about the downside of the screening tests, and how they can instantly turn you from a healthy person into a sick person in need of treatment, and how the guidelines for what constitutes "health" keep being ratcheted downward in order to sell more drugs. He makes the point that much of the resources used to search for sickness in healthy people would be better spent in looking for ways to treat people who are actually sick. He also reveals how the statistics are manipulated to sound more impressive than they actually are.
on February 12, 2011
« Overdiagnosed » turns the slogan "don't bury your head in the sand", used for promoting screening, against it. Living examples and hard facts provided by Dr Welch give evidence that the more you look for disease among healthy people, the more you find pseudodisease that would not have had any damagable consequences for your health. This happens for high blood pressure, diabetes, hypercholesterolemia, osteoporosis, gallstone, damaged knee cartilage, bulging discs, abdominal aortic aneurysms, blood clots, cancer, and much more ! I bet that pretty soon, all healthy readers will thank Dr Welch for his chapter « We confuse DNA with disease ; how genetic testing will give you almost anything ». Delightful examples including wrong dogmas in other fields enlight the demonstration. Drawbacks due to overdiagnosis are so convincing that you easily catch how dwelling on the diseases you may (or may not) develop actually poisons life. Anxiety leads to too much medical care that leads to overdiagnosis that leads in turn to side effects of overtreatment. Before reading this book, you may wrongly fear disease. After reading it, you wisely fear medical misappropriate care. Here is the conclusion : Enjoy living healthy to be strong enough for facing adversity when it (ever) comes.
on February 13, 2011
Overdiagnosed peers into the triad of interests that subject persons not at risk for serious illness to unneeded worry, testing, and potentially harmful intervention. The three are: (1) physicians who sustain at least parts of their practices by over-screening and over-diagnosing, (2) pharmaceutical and medical-device companies who reap the benefits of broad-range screening and early treatment for discovered "abnormalities" that may never (whether treated or not) develop beyond the phantom stage, and (3) the legal system's retrospectoscope that imposes liability on health-care professionals for the relatively rare missed diagnosis (this latter reality prompts even those physicians who do not directly benefit from over-screening and over-diagnosis to practice "defensive medicine," resulting in a multiplier effect that amplifies the costs to patents and to an already overburdened health-care system). Sadly, the media, which hardly ever looks at issues in depth, magnifies the problem because of their constant calls for more and more and earlier and earlier screening of folks who have no identifiable symptoms.
Simply put, as Dr. H. Gilbert Welch and his colleagues tell us in a lucidly written and well-supported examination of the problem, the over-diagnosers and those who benefit from over-diagnosis exploit (knowingly or unknowingly) the natural quest for perfect health and the concomitant rush to fix blame on others when things go wrong.
Overdiagnosed should be read by everyone: health-care and legal-system professionals, the media, and, of course, potential patients everywhere.
Simply put, as Dr. H. Gilbert Welch and his colleagues tell us in a lucidly written and well-supported examination of the problem, the over-diagnosers and those who benefit from over-diagnosis exploit (knowingly or unknowingly) the natural quest for perfect health and the concomitant rush to fix blame on others when things go wrong.
Overdiagnosed should be read by everyone: health-care and legal-system professionals, the media, and, of course, potential patients everywhere.
on August 26, 2011
Overdiagnosed by Welch is an excellent book. It reveals the serious mistake healthy people can make by submitting to screening tests, and the hazards of being uninformed about health maintainance. Education is key, and Welch is here to teach. It is, indeed, a sad medical community that allows monetary factors, fear, public presssure, and ignorance to harm healthy patients. The book is interesting, intelligent (but understandable if you are not afraid to think), and reflects the authors personal voice. His voice is true, but controlled. If you want a sharper and more illuminating discussion of overmedicalization, read Nortin Hadler. Hadler's writings will rock you! But Welch has an excellent work, and we are better off for its publication. It is required reading.
on January 28, 2017
Every person in America should read this, especially Doctors! So sad how conventional medicine is making" WELL" people sick. You don't even have to read the whole book( you'll want to), but just reading the jacket will give you the picture! If you fall for some of the misguided ways of modern medicine it's you're own fault. There's a place for conventional medicine, but just read the book and if you have any kind of open mind, you'll see what I mean. Most doctors are good doctors, they just need more information.
on July 4, 2011
The rationale for the increasing emphasis on diagnosis
In Overdiagnosed, H. Gilbert Welch, with Lisa M. Schwartz, and Steven Woloshin, explains how the medical profession has an increasing tendency to make diagnosis which is not good for us. The rationale for more diagnosis seems good. When we diagnose more we are able to detect abnormalities, like cancer, high blood pressure, diabetes, high cholesterol, etc., earlier so that we can treat them earlier and prevent serious health problems. An example of this greater emphasis on diagnosis is the prevalence of disease awareness campaigns which encourage people to undergo medical screenings. Another example of increased tendency to diagnose is when doctors have patients tested for things about which they have no complaints.
When are abnormalities dangerous?
Although more diagnosis may sound good, according to the author it is actually, on balance, not when it leads to overdiagnosis. Overdiagnosis is the detection of abnormalities which are harmless. Overdiagnosis is likely to happen when diagnosis is done when there are no symptoms. What is important to know is that many asymptomatic people have abnormalities of some kind which are no threat for their health and which will never become a threat to their health. Some of these unharmful abnormalities may fall into innocent sounding categories like slight overweight, or pain in the knee, but some unharmful abnormalities involve terribly dangerous sounding words like stroke, cancer, high blood pressure, diabetes, high cholesterol, etc. While all these dangerous sounding words may involve abnormalities which indeed can kill you, in many cases abnormalities like these won't kill you or even harm you. For instance a study found that 10 percent of healthy participants had had strokes (silent strokes) without them being aware of it. Another example is that a large percentage of adults have some evidence of thyroid cancer. For most of them this will never become dangerous because cancers are often static or progress extremely slowly. Some abnormalities are dangerous, many abnormalities aren't. How does the medical profession decide when abnormalities should be considered pathological?
How lowering cutoffs creates new patients
Medical professionals consider an abnormality pathological when the value they find in a diagnosis is above a certain cutoff score. This cutoff score is not something which is purely scientifically established. The distinction between abnormal and normal can be rather arbitrary. The author explains that cutoffs are defined by panels of physicians and they involve not only scientific judgments but also personal values and opinions and financial interests. Cutoffs are also not fixed. They frequently change over time. The direction of this change has been to set cutoffs lower and lower. Due to this, the threshold to make a diagnosis has fallen and the number of individuals who are labeled sick has increased, often dramatically. Lowering the cutoff only slightly, creates a great number of new 'patients'.
What forces drive the lowering of cutoffs?
The author mentions at least three forces driving the lowering of cutoffs. First, there is the true belief by many that early detection is a good thing because it can prevent worse. Second, new technology enables medical professionals to screen more easily, cheaper and more refined. Third, finding more abnormalities and defining these abnormalities more and more as pathological enlarges the medical market which leads to financial benefits. The author explains that this third force is a dangerous one. He says the commercialization of medicine is a corrupting force. It may have been fine if medical care would have been a free market but it is nowhere close to being a free market. Sellers in the medical care market create demand for their wares by being in the position to decide whether or not you need to consume their products. Turning more people into patients is (like) expanding the market, something of which the whole medical-industrial complex financially benefits. Medical research is also negatively affected by commercialization. In order to do research researchers have to apply for grant money. Decisions about grants for research are not only often made by the commercial companies like the pharmaceutical industry (most medical research is now funded by industry) but also by other researchers who are wedded to conventional ideas and approaches. Sympathetic sounding disease awareness campaigns also increasingly involve paid advertising.
What is the problem with more diagnosis and lower diagnosis thresholds?
More diagnosis and lower thresholds lead to more treatments. A cycle of seeing more, finding more, and doing more emerges. People with small abnormalities will be treated more than was the case before. There are two problems with this. First, people with milder abnormalities stand to benefit less from treatment than those with severe abnormalities. A few may be helped but many will be overdiagnosed and some of them will be harmed and no one knows who.
Second, being diagnosed and being treated has some serious disadvantages. There are potential psychological (for example viewing oneself as a patient), practical (for example not being admitted to insurance), financial (for example spending more on healthcare) and medical harms (for example side effects, sometimes very serious, even life threatening) of being diagnosed and treated. When patients have seriously threatening abnormalities there is often little that can be done about these harms. In those cases treatment is necessary and its benefits outweigh the negative effects of being diagnosed and treated. But for patient with mild abnormalities chances are that negative effects of being diagnosed and treated outweigh its medical benefits.
If it ain't broken ...
This book is not a criticism against conventional health care. It does not advocate alternative healthcare. It is also not against diagnosis and treatment. On the contrary, the author is all for conventional healthcare and urges people with symptoms to talk to their doctor. It is diagnosis and treatment in the absense of symptoms the author warns against. Often, it is wise to remember: if it ain't broken, don't fix it.
In Overdiagnosed, H. Gilbert Welch, with Lisa M. Schwartz, and Steven Woloshin, explains how the medical profession has an increasing tendency to make diagnosis which is not good for us. The rationale for more diagnosis seems good. When we diagnose more we are able to detect abnormalities, like cancer, high blood pressure, diabetes, high cholesterol, etc., earlier so that we can treat them earlier and prevent serious health problems. An example of this greater emphasis on diagnosis is the prevalence of disease awareness campaigns which encourage people to undergo medical screenings. Another example of increased tendency to diagnose is when doctors have patients tested for things about which they have no complaints.
When are abnormalities dangerous?
Although more diagnosis may sound good, according to the author it is actually, on balance, not when it leads to overdiagnosis. Overdiagnosis is the detection of abnormalities which are harmless. Overdiagnosis is likely to happen when diagnosis is done when there are no symptoms. What is important to know is that many asymptomatic people have abnormalities of some kind which are no threat for their health and which will never become a threat to their health. Some of these unharmful abnormalities may fall into innocent sounding categories like slight overweight, or pain in the knee, but some unharmful abnormalities involve terribly dangerous sounding words like stroke, cancer, high blood pressure, diabetes, high cholesterol, etc. While all these dangerous sounding words may involve abnormalities which indeed can kill you, in many cases abnormalities like these won't kill you or even harm you. For instance a study found that 10 percent of healthy participants had had strokes (silent strokes) without them being aware of it. Another example is that a large percentage of adults have some evidence of thyroid cancer. For most of them this will never become dangerous because cancers are often static or progress extremely slowly. Some abnormalities are dangerous, many abnormalities aren't. How does the medical profession decide when abnormalities should be considered pathological?
How lowering cutoffs creates new patients
Medical professionals consider an abnormality pathological when the value they find in a diagnosis is above a certain cutoff score. This cutoff score is not something which is purely scientifically established. The distinction between abnormal and normal can be rather arbitrary. The author explains that cutoffs are defined by panels of physicians and they involve not only scientific judgments but also personal values and opinions and financial interests. Cutoffs are also not fixed. They frequently change over time. The direction of this change has been to set cutoffs lower and lower. Due to this, the threshold to make a diagnosis has fallen and the number of individuals who are labeled sick has increased, often dramatically. Lowering the cutoff only slightly, creates a great number of new 'patients'.
What forces drive the lowering of cutoffs?
The author mentions at least three forces driving the lowering of cutoffs. First, there is the true belief by many that early detection is a good thing because it can prevent worse. Second, new technology enables medical professionals to screen more easily, cheaper and more refined. Third, finding more abnormalities and defining these abnormalities more and more as pathological enlarges the medical market which leads to financial benefits. The author explains that this third force is a dangerous one. He says the commercialization of medicine is a corrupting force. It may have been fine if medical care would have been a free market but it is nowhere close to being a free market. Sellers in the medical care market create demand for their wares by being in the position to decide whether or not you need to consume their products. Turning more people into patients is (like) expanding the market, something of which the whole medical-industrial complex financially benefits. Medical research is also negatively affected by commercialization. In order to do research researchers have to apply for grant money. Decisions about grants for research are not only often made by the commercial companies like the pharmaceutical industry (most medical research is now funded by industry) but also by other researchers who are wedded to conventional ideas and approaches. Sympathetic sounding disease awareness campaigns also increasingly involve paid advertising.
What is the problem with more diagnosis and lower diagnosis thresholds?
More diagnosis and lower thresholds lead to more treatments. A cycle of seeing more, finding more, and doing more emerges. People with small abnormalities will be treated more than was the case before. There are two problems with this. First, people with milder abnormalities stand to benefit less from treatment than those with severe abnormalities. A few may be helped but many will be overdiagnosed and some of them will be harmed and no one knows who.
Second, being diagnosed and being treated has some serious disadvantages. There are potential psychological (for example viewing oneself as a patient), practical (for example not being admitted to insurance), financial (for example spending more on healthcare) and medical harms (for example side effects, sometimes very serious, even life threatening) of being diagnosed and treated. When patients have seriously threatening abnormalities there is often little that can be done about these harms. In those cases treatment is necessary and its benefits outweigh the negative effects of being diagnosed and treated. But for patient with mild abnormalities chances are that negative effects of being diagnosed and treated outweigh its medical benefits.
If it ain't broken ...
This book is not a criticism against conventional health care. It does not advocate alternative healthcare. It is also not against diagnosis and treatment. On the contrary, the author is all for conventional healthcare and urges people with symptoms to talk to their doctor. It is diagnosis and treatment in the absense of symptoms the author warns against. Often, it is wise to remember: if it ain't broken, don't fix it.
