Overdiagnosed

Making People Sick in Pursuit of Health

By: Dr. H. Gilbert Welch, Dr. Steven Woloshin, Dr. Lisa M. Schwartz

Narrated by: Sean Runnette

Length: 9 hrs and 37 mins

Publisher's summary

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.

Drawing on 25 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 pre-disease. 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.

©2011 Dr. H. Gilbert Welch (P)2012 HighBridge Company

Critic reviews

"This accessible and important book will help the reader understand the limitations of modern medicine and the perils inherent in an overzealous pursuit of a disease-free existence at any cost. It is also especially timely in raising one of the many issues surrounding the health-care debate." (Dennis Rosen, The Boston Globe)

"One of the big strengths of this relatively small book is that if you are inclined to ponder medicine's larger questions, you get to tour them all. What is health, really? In the finite endeavor that is life, when is it permissible to stop preventing things? And if the big questions just make you itchy, you can concentrate on the numbers instead: The authors explain most of the important statistical concepts behind evidence-based medicine in about as friendly a way as you are likely to find. (Abigail Zuger, M.D., The New York Times)

Excellent Book

This book provides clear arguments and gives everyone much needed information on the process of diagnoses. The authors are also careful not to talk negatively about people, but instead provide their opinions and feel that people should understand all of the risks that goes into different tests they might be asked to complete.

Our Broken Medical System

If you aren't already afraid of what is going on in our health care system, this book will do it for you. It presents concrete evidence of many things that go on that clearly aren't working, that clearly are making many of us worse instead of better. Remember that most of our health care is driven by for profit businesses, and greed corrupts. Providers may look like they have your best interests in mind but that isn't necessarily so. Read the book, and then think very carefully about how you want to manage your own health. I'm a nurse and I have seen it from the inside. This book confirms a lot of what I have felt and suspected.

Important information for patients

I wasn't sure what to expect going into this. I thought this might be a crackpot doctor casting doubt on modern medicine and pushing unfounded alternative medicine practices.

Instead, this is the result of one experienced and frustrated doctor (backed up by two co-authors) providing copious evidence for his viewpoint: the sometimes reasonably healthy people are unnecessarily diagnosed with a condition, and that diagnosis - and the stress and treatments that result - can cause harm.

Put it another way. Heart attacks kill a lot of people. Should we put absolutely everyone on blood thinners in the hopes of preventing heart attacks? That would be ridiculous. That's unnecessary cost and hassle, and the side effects could be quite hazardous. Someone should only be put on blood thinners if that individual has a significant likelihood of a heart attack in the near future. It's not a simple on/off determination. It's a matter of balancing risks, of determining when the risk of the ailment is large enough to justify the risk of applying the treatment.

The authors make the case that in many cases, this calculation veers far too heavily towards overdiagnosis and overtreatment. After all, as they point out, the consequences for not diagnosing or not treating a condition can be grave. But there are no consequences for being "too cautious". For erring on the side of overdiagnosis and overtreatment - even when that can cause more harm than good.

The authors make use of many studies in the text in order to justify their points, but leavened by humanizing anecdotes of specific patients and personal stories. It was an interesting read. More than that, it's an important read.

The older I get and the more doctors I go to, the more I realize how severely flawed the medical institution is. Don't get me wrong. Medical science is real science. We are much better off with modern medicine than without, and I am grateful for it. But the flaws, from a patient's perspective, are obvious. The key takeaway is that blindly relying on whatever doctor you happen to see is foolish. You need to take responsibility for your own healthcare. Ask questions. Look up information about diagnoses and treatments. Make sure you're informed about the actual risks, both of a disease and of the treatments. With that in mind, I think this book is a valuable read, to help patients prepare to be more engaged and careful in their treatment decisions.

Overdiagnosed

The authors make a strong case that over prescribed medical tests are a net negative not only on medical costs but more importantly on health of patients. This is a very worthwhile book.

Outstanding!

A must read for every physician.

The author brilliantly defends a paradigm shift in health care.

A must read also for health care consumers who wants to become better informed in their interactions with the health care system; especially when facing the question of doing or not tests for the early detection of diseases. Early detection has bigger risks than most of us think.

This is the book I wanted to write.

This is the information everyone is missing whenever Healthcare is discussed.
You cannot understand how to structure a Healthcare system, if you don't understand its strengths and weaknesses. Moreover, Welch gets to the heart of what is driving our Healthcare decisions today. He understands the difference between more Healthcare and better Healthcare and that they are not synonymous.
Without a paradigm shift we will put an end to good doctors focusing on quality of life and usher in the quantity of life system.

The Medical Empire hates these facts!

Would you recommend this audiobook to a friend? If so, why?

To all my friends, and I am going to give this book as a gift to about 10 people I care very much about hoping they will read it.

What does Sean Runnette bring to the story that you wouldn’t experience if you just read the book?

The facts and statistics could be overwhelming but the narrator's inflection and cadence
( pacing) make it so engaging. My favorite phrase is ...beginning a cascade of medical interventions! cascade is perfect for the concepts we don't want to hear but are true. Everyone wants hope but this hope is an illusion to maintain a lucrative industry. If you choose to listen you will wonder if the authors know your health story because we have a one size fits all approach to health and it is very expensive. Oh, but don't worry as the billing secretary says, insurance covers it. Yes but I would like to know what you charges are and what for. Try it. You will not get the details, or like me they will suggest you get another dr.

Was there a moment in the book that particularly moved you?

Yes, the high blood pressure "game" and the mammogram "game."

Any additional comments?

someone I respect once told me people treat you the way you let them...True for doctors only they are much more intimidating. also follow the dollar if you want the truth. and thank you audible for all these books.

Everyone Should Read this Book

I am a skeptic and this book reinforces my thinking. As a pastor I witnessed too many people lose their quality of life by being over diagnosed.

Outstanding

Well structured excellent performance Dr eat analogies. One of the best audio books I have listener

A powerful outline of a problem, but no solution

What did you love best about Overdiagnosed?

I appreciated that the authors synthesized real data with real experiences to bring the problem of over-diagnosis to light. Challenging the current paradigm with weak evidence and abstract reasoning simply does not work. The authors were able to overcome this barrier with careful explanation and examples in each case and built a compelling story for the reader. As a future doctor, this was an important insight to me for my future practice.

Any additional comments?

My biggest problem with this book lies with the authors' lack of solutions. They certainly examined the problem from every angle, to the point of perhaps over-diagnosing their own problem. After 10 hours of discussion on the problem I noted only a minute here or there commenting on possible solutions. The best they could arrive at was "be cautious about early diagnosis." It is certainly poor medical practice to provide a diagnosis without also providing a treatment plan and prognosis, which this work lacked. In the end it was a beautiful description of a current medical issue but left a lot of things unsaid and untouched.