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    Overdiagnosed: Making People Sick in Pursuit of Health
    Overdiagnosed: Making People Sick in Pursuit of Health
    Overdiagnosed: Making People Sick in Pursuit of Health
    Audiobook9 hours

    Overdiagnosed: Making People Sick in Pursuit of Health

    Written by Lisa M. Schwartz, MD, H. Gilbert Welch, MD and Steven Woloshin, MD

    Narrated by Sean Runnette

    4.5/5

    ()

    About this audiobook

    Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. #160;#160;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 #8220;pre-disease.#8221; 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.
    LanguageEnglish
    PublisherHighbridge Company
    Release dateSep 11, 2012
    ISBN9781611749649
    Overdiagnosed: Making People Sick in Pursuit of Health

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    Reviews for Overdiagnosed

    4.5/5

    29 ratings9 reviews

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    • 5/5
      Required reading for medical tourists like myself who get very much optional screening tests (scans, blood tests etc) done in Vietnam, Malaysia, Thailand and India because we are not happy with monopoly healthcare insurance and rationing of medical care in Canada. 'Food for thought' to say the least. Do have to admit that at both Hanoi Heart Hospital and Sunrise Japan Hospital in Cambodia, physicians talked me out of unnecessary tests.

      1 person found this helpful

    • 5/5
      The author is balanced, fair, and well researched about an extremely important topic that affects people involved with modern medicine. I think the book should be required reading for all who use allelopathic medicine. I will never think the same way about screening, diagnoses, or doctors. The book made me feel freer and more empowered about my body. Thank you Dr. Welch!
    • 4/5
      Should be required reading; it does have math in it, but be a big kid and read on- it's worth it. Sort like math and probability meet the medical profession. Doctors are trying to help their patients, but it just may be all the new technology and testing are not doing us as patients as much help as one might think. Basic lesson- no one is perfect and these superduper CT/MRI tests WILL find something awry just because we are not perfect systems. Money is an issue- I got the insurance report and my knee MRI cost $2000. Yikes. Someone MAY be making a profit here.If I were paying for it myself, I sure would not have taken one. There is so much here to talk about and learn, just read the book- even if you have to skim some parts.
    • 5/5
      This is probably one of the most important books I've ever read related to health. I would recommend it to most anyone. Best to read it when you're healthy (or mostly so), *before* getting any scans, tests, or diagnoses. There are times to seek medical care, doctors, and diagnosis - and there are times that they are best avoided.
    • 4/5
      Bashing the status quo is a common theme in popular health and medical non-fiction. Atul Gawande did it in Being Mortal, where he dispels the notion that extending lifespan is the sole goal of treating the elderly. Giles Yeo did it in his anti-diet Gene Eating. Overdiagnosed has a similar mission, this time targeting the need to find and correct every minor abnormality. It is, of course, a problem concentrated in the First World, where doctors, patients and corporations conspire with varying degrees of good will to achieve what statistics prescribe to be the healthy norm. To be more precise, Welch focuses on the US with its peculiar system of health insurance: "The United States is one of only two countries in the world that allow direct-to-consumer advertising of prescription drugs (the other is New Zealand)."Welch takes a systematic look at some of the causes of overdiagnosis: (1) narrowing the acceptable range for metrics such as blood pressure, blood sugar and PSA (prostate specific antigen); (2) more powerful and frequent scans causing increased findings of benign abnormalities known as "incidentalomas"; (3) aggressive sampling of tissues to find indicators of cancer which may never cause a problem; (4) mail-order DNA analysis encouraging people to look for problems which may not exist.I did enjoy Welch's journalistic exposé, partly because I am from the school of thought that healthy diet and activity should be the main focus for the average Joe rather than trying to preempt far-off conditions and diseases. As Welch puts it, "There is no need to do a genetic test to learn about the common, powerful risk factors for diabetes: obesity, sedentary lifestyle, and family history." The highlights for me are the statistical data which show how overdiagnosis "creates" problems; lucid explanations of cognitive biases which affect how statistics are presented and how we perceive them; and how positive feedback loops drive an endless cycle of testing and treatment.Like Gawande, Welch believes treatment should be a collaboration between patient and doctor: "When we have major responsibilities to others, such as young children, we are likely to place more value on the 'staying alive' side of the equation. But later in life, we may place more value on 'staying well.' So we should expect that people will make different decisions about early diagnosis and that individuals’ decisions may change over time." Absolutely right.Here I wish to record three of the biases which the layperson should keep in mind. First, absolute risk is more important than relative risk. Saying you are three times more likely to survive a condition if it is caught early via frequent testing is not useful if that condition's prevalence is one in a million and you are not otherwise predisposed. Second, survival rate statistics are plagued by lead-time bias. If two people die from a disease at 80, one was diagnosed at 74 via a regular test and the other at 76 when symptoms first present themselves, it's not helpful to consider the first person as having a longer survival rate. Third, overdiagnosis bias, while difficult to quantify because of the scale of studies required, is very real. If you "find" 50% more patients with a condition by narrowing your criteria, many of these relatively minor conditions will never materialise in ill health.There are a few issues which I do not feel Welch adequately addressed. The obesity epidemic is absolutely real in the First World. Doctors and health practitioners need to play an active role in promoting good health in the overweight or malnourished. Metrics such as BMI are useful in this regard, but ranges need to be adjusted for ethnicity and considered alongside diet and exercise. Borderline high cholesterol, blood sugar and blood pressure in conjunction with being overweight need to treated differently to a single errant reading in a person who otherwise feels fine.Another issue is how Welch in his zeal sometimes downgrades common practice as harmful with little evidence. Genetics has little value: "With the exception of a few relatively uncommon genetic mutations, by far the most important risk factor for breast cancer is a woman’s age." Yet that's the point: a doctor can and should use genetics if there is a family history and reasonable penetrance of cancer-associated genes. It's a tool to help people measure and manage risk rather than a factor which itself determines treatment. Even ultrasounds for pregnant women are harmful, despite being cost effective and physically safe, because of the psychological impact of false positives.Welch is on a mission and his arguments are certainly one-sided. That said, sometimes you need a one-sided exposé to redress the balance of public opinion.
    • 4/5
      This is a book all healthcare consumers should read. Even if you don't end up agreeing with everything the author says, it will give you tools to better evaluate what diagnostic screening tests you should use and the often hidden risks behind much of the medical screening that is done. Americans spend more on healthcare than anyone in the world and this book shows part of the reason for that. You also might be healthier and have greater peace of mind if you choose to forego many of the diagnostic tests on offer.
    • 3/5
      This book provides good information about how modern medicine has altered the criteria of diseases and how that leads to over diagnosis and over treatment. Welch discusses the ramifications of over diagnosis and over treatment in the health care system, insurance companies and patients. Overall, this book was full of good information with well reasoned arguments against some of the trends in medicine. At times I thought that the writing was a bit dull, but thankfully those bits were few and far between.
    • 5/5
      The book is well written and well researched. I appreciate the honesty and patient caring personality of the author. I feel that his perspective is correct but not well understood. I strongly recommend this book.
    • 5/5
      Important book about the information age turning us all into patients. The PSA test for prostate cancer will serve as a quick example. Now that the test exists, men are told they should get it. A score of 2.5 or above is bad--cancer lurks. So everybody above 2.4 becomes a "cancer" patient. Their lives are changed forever. And people with 2.2? Not exactly likely to relax. What will next year's test bring? All this worry and fear despite the fact that prostate cancer is slow growing and kills approximately 3 out of 1000 males. This type of overdiagnoses occurs with breast cancer, thyroid cancer, lung cancer, etc. etc. We are living longer than ever, yet we think of ourselves as sicker than our parents thought of themselves. Way too much information! Welch suggests, in a nutshell, that unless you actually have symptoms, don't get caught up in the testing trap. I think it is great advice.