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on July 6, 2015
I want to give this book to every friend and relative...except since many work in healthcare and are therefore dismiss anybody who questions the Infallibility of Science as a "kook," I doubt they'd read it. So unfortunately they will continue to be scoped and scanned and overdiagnosed and overtreated to prevent diseases and disorders they're never going to get anyway.

My 93-year-old father has now outlived 2 doctors who insisted he needed statins because his "bad cholesterol" was abnormal even though his ratio was less than 2. And my mother died as the result of a car accident at the age of 85 after having been urged for 20 years to have a hysterectomy because there was a "shadow" on her uterus...a shadow which was discovered when they were treating her for something else. There's a whole chapter in the book on "incidentalomas" ie things high-powered imaging machines can discover when they're looking at something else. These discoveries have a way of cascading into treatments that sometimes injure and even kill people.

Every chapter resonated with me. I'd found it when I was googling to understand why my Fasting Blood Sugar of 104 was healthy in 2002, but now was considered "prediabetic." At least, it is in the U.S. where the American Diabetic Association unilaterally moved the range of normal.

All I have to do is move to Canada if I want to be cured.
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on April 17, 2015
Let me start by admitting my own confirmation bias. I have thought for a long time that we are over-medicalizing people and turning healthy people into patients. But I am a layperson and did not have the data to prove it. I am not a researcher. So, this was just intuition.

After reading H. Gilbert Welch's book, I have the data that confirmed my hunch. But I approached it with an open mind, as I do most of the media reports I've read about screening recommendations and the newest guidelines for who should take statins, when they should begin, etc. I try to be willing to listen to the real medical people and researchers. But I often get the nagging sensation that somewhere, years in the future, a meta analysis will come out disputing their current guidelines. It's certainly happened often enough in history.

So reading Dr. Welch, as he walks the reader through a careful analysis of the guidelines; a review of the evidence, including an explanation of what the statistics really say; and an explanation of the harms that overdiagnosis can cause, is refreshing and eye opening.

According to the good doctor, overdiagnosis is a long recognized problem in the medical field and it can lead to over-treatment of conditions that might never cause symptoms or harm the patient. But the treatment can, and often does, have side effects, some of which can have lifelong negative impact on the patient's health. Some of which can even lead to death.

Dr. Welch takes readers through a real analysis of cost versus benefit of screening and early and aggressive treatment of patients. 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. And he admits that there are times that catching a tumor when it is smaller and before it has spread leads to significantly better outcomes. The problem, though, is that many tumors are not deadly and will never grow or be threatening. But nobody can know which will tumors will be aggressive and deadly. So, once they are discovered, through screening, doctors often feel obligated to treat them all with equally aggressive treatments. An aggressive approach to a deadly cancer may be medically justified, but the same approach to one that may be dormant and never cause a problem is not justified, especially if it contains serious risks to life and health. The problem is with early screening you catch more of both types of anomalies and can't know the difference.

Dr. Welch argues that, in fact, while more cancers are diagnosed earlier, the rate of death has not gone down. You may have many seeming cures, but if the death rate has not been altered, it could just mean that more cancers that were never deadly have been overdiagnosed and treated, with accompanying unnecessary risks to the patient.

He does not advocate no screenings. In most cases, he suggests learning all the facts, weighing the risks, discussing it with one's doctor, and making informed decisions about when to be screened. He is neither anti-science nor opposed to traditional, Western medicine. He is a doctor whose own practice follows standard, modern protocols. And he uses his research knowledge to back up his claims with solid data. He also intersperses his arguments with personal anecdotes that demonstrate his arguments. But the anecdotes do not take the place of data, on which he spends most of the book.

Some of it gets repetitive and I found myself skimming toward the end when he seemed to be repeating his arguments over and over again. That is because he goes into great depth of analysis on a variety of different cancers that are screened for and the evidence always turned up the same facts, that too aggressive screening led to overdiagnosis, aggressive treatment, and potential harms, over and over again.

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 the U.S. Preventive Health Services, the group responsible for many of the revisions to the screening guidelines that made headlines in 2009. Read Dr. Welch's books, talks to your doctor, and make more informed choices regarding your health.
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on November 10, 2015
This is an enormously important book. After several tries with new doctors, during which my questions never got answered but a script was followed recommending all sorts of unnecessary tests, I found and read this book eagerly. My story was right there. Recently at one attempt to find a new primary care doctor, I was kept waiting by another specialist for an hour and a half. I was nearly late for the PC appointment and by the time I finally got through all the stress, my blood pressure had zoomed up from normal to thirty points higher. So in other words trying to get a PC that would listen caused me to develop a (temporary) health problem. Immediately when she saw the new blood pressure reading, she started "treating your high blood pressure!" In addition to the damage doctors today can do to protect themselves (what ever happened to putting patients first?), overwriting must be causing billions of wasted dollars in our health care system.

What I wish was in this book, what I found missing, was Dr. Welch's guidelines for finding a doctor who will treat me like a human being, not a product to be milked for profit in a clinical factory. How can we find caring practitioners? Dr. Welch, please write another book on this very important subject.

I would highly, highly recommend that every person without a caring physician read this book. Thank you, Dr. Welch, for writing it. And I should add that Dr. Welch is not a "holistic" healer, but a practicing MD who teaches at Dartmouth Medical College. But I am so disenchanted by and even afraid of current doctors that I might seek out just such a "holistic" healer, one who actually practices that old first rule of medicine: do no harm. Better that than paying a small fortune to have a traditional doctor make you sick.
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on February 14, 2016
OVERDIAGNOSED brings to light a concern that too few Americans have. We trust out doctors and trust their tests so much that we don't even blink an eye at their diagnoses. The result? More people are sicker and more people accept treatments that are at best insignificant and at worst harmful. The author concentrates on America's common ailments (cancer, diabetes, and high blood pressure), although the principles can be applied to anything. The author considers the number of people who benefit from their doctors' diagnoses and those who spend countless dollars testing for an ailment they never likely had.

This book is insightful, although the writing is lackluster. It's very boring. The author uses charts to prove his point, making this more like a text book than pleasurable reading. This book is great for reference but not something you'd read for pleasure. I found the information helpful and kept this book for future reference.
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on May 31, 2014
Taking a simple everyday issue like acne or menopause or not being able to sleep and turning it into an illness. Scaring people into getting a mammogram every year after 30 or 40, lowering the "cholesterol number" to get more and more people on statins, and on and on. The DTC advertising on TV is fraught with scare tactics. This book will help you understand what's happening with your medical care.

Years ago when I was a young homemaker, I like most other women would buy women's magazines like Women's Day, Good Housekeeping, etc. In the late 70's I noticed more and more "medical" articles. Few and far between at first nestled right along side of articles like, "How To Create A Great Christmas Experience For Your Family", etc. They then became more and more prevalent. People were becoming indoctrinated to the medical information that they MUST KNOW so they don't die. That's when I stopped buying those magazine. Who needs to be frightened into thinking you have myasthenia gravis because you blinked 3 times in the last hour!

Overdiagnosed is written in layman's terms and helps ordinary people understand that medicine is big business these days. If a doctor can get a woman in for a mammogram because she suspects a problem, that doctor may see 3 or 4 of these types of issues in a month. On the other hand, if medicine can scare hundreds of thousands of women into thinking that if they don't have the mammogram they are "at risk" then you will fill up your medical calendar and your revenue will soar...and so will the hospital revenue and the medial device manufacturer's revenue.

Read this book. It brings common sense back to medicine. It tells you clearly when you need to be concerned about your health and when you are being hyped by the advertising/medical business.

I highly recommend Overdiagnosed!
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on February 17, 2016
This is a compelling view of our (challenged) health care system. It's not a fast read; it's filled with statistics, situations and information which personally confirms my perspective of our health care system.

I am very stubborn and protective about my health and recently challenged a doctor's recommendation for surgery, opting instead for additional physical therapy for my injury. Although PT initially took more time, I recovered completely and in better shape than before the injury. (Plantar fasciitis, sprained knee, tendons & ligament strains, etc). I declined the narcotic pain medication (Norco) and when I was achy, I took Advil or Tylenol.

I have recommended this book to others and bought one for my husband. Honest, sometime brutal but telling. Excellent.
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on March 13, 2015
THANK YOU THANK YOU THANK YOU for writing this book. Everyone needs to read this book. It is very well written,, and easy to read, and actually overall, a pleasant book to read., It is detailed enough to be a practical help. Basically it explains how early diagnostics is not what it is made up to be and can be dangerous to your physical and mental health and over all well-being. It clearly explains how statistics are used to lie to you, and how others personal accounts can mislead you in making a decision. It explains why doctors have to order tests, Let me tell you, reading this book is a good use of any ones time. You need to be educated on testing and how things are presented to you. Remember, being over diagnosed means getting treatment not needed (or of no value) and often harmful and can snowball into serious problems when you really had no problem to start with. And please, do not speed read through this - take your time and learn.
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on June 8, 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,
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on May 4, 2015
This is a very thoughtful and careful analysis of the impact of the flood of "wellness" screening that so many of us are subjected to. For myself, if I don't comply with certain screening tests, my insurance jacks up my rates $1200 a year. So of course, I have the tests done. However, it was abundantly clear that the doctor I went to see saw me as only a series of boxes to be checked off. There was no opportunity to discuss alternatives to invasive tests such as colonoscopy or tests involving radiation like mammography, both of which I'd prefer to avoid and both of which have alternative tests (and which I did). I guess I need to shop harder for a doctor who doesn't see her patients as a form that needs to be completed.
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on May 26, 2015
I liked this book very much. Perhaps because I wholeheartedly agree with the subject matter. The problem with overdiagnosis is that people are named sick, when they have no symptoms of disease. It is a serious and expensive problem. Everyone should read this book so they are better informed when seeing their medical provider. What tests to have done and what follow up evaluations make sense are discussed. The physician-writer gives some interesting case histories to back his viewpoint. Other physicians will disagree, but after reading this book, the patient will be better prepared to discuss what tests or procedures are logical.
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