Top critical review
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Everyone should read this book
on October 31, 2015
Yes, I have a number of problems with this book, but let me say clearly, I do believe that just about everyone should read it. There is an important point to be made about how our medical outlook has changed from responding to symptoms, to now, symptomless people, looking for problems when no symptoms exist. There is certainly something to be said for finding certain diseases in their earlier stages for more effective solutions. But this book brings out the important point that, along with finding dangerous beginnings of diseases, we are also diagnosing diseases that actually do not produce a danger. The premise of the book is that for every disease that is caught early, there may be 10 “diagnoses” of “potential diseases” (those are my numbers) that do not need remedy. In some cases, finding these diseases early does not make a real difference in their solution, versus catching the disease when symptoms show. In other cases, there are diseases and cancers that do not progress to a dangerous level and treating these diseases aggressively often causes much more harm than good.
Is it worth the many “over-diagnoses” to save those found through early detection? The reality is that these odds may not be what we think. There are many interesting statistics in this book, but I am not completely convinced by all of them. However, it does seem clear that patients often do not get a balanced opinion of the real options (of screening) and their potential outcomes. Among other things, the book explains clearly—and I really get it—why men over 70 should not be tested for prostate cancer, using the PSA test. It’s too involved to explain here, but it is one of those things that is explained clearly here and this has changed what I will do about that.
I do think the book is somewhat one-sided and also I find it somewhat annoying that he repeats himself a lot. It is for these reasons that I downgrade the star rating somewhat, but as I said at the beginning, this is an important point of view that could—and probably should—change some minds about when to screen for some diseases and when to follow up—or not.