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)

Outstanding

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

BECOMING A BETTER CONSUMER OF MEDICAL CARE

OK. So this book fit right in with my preconceived notions of the medical establishment, but.... we really need to ask more questions of our doctors before following AMA treatment guidelines, which keep moving anyway. I loved this book because now I know I'm not simply doctor phobic, I have a reason to be sceptical. After all, you are not paranoid if they are really out to get you.

Great audiobook

Best delivered audiobook I've heard. Voice perfectly matches material. Explores a new look at what we do when treating healthy patients.
Dr Welch lays out his arguments with witty, clean and clear language showing how ideas about preventive care have gone astray and how they are conveyed to providers and patients in a misleading way. A very important book for all of us to read.

Everyone should read this book!

If you could sum up Overdiagnosed in three words, what would they be?

Essential, enlightening, frightening

Who was your favorite character and why?

Dr. Welch, of course!

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

Since it's non-fiction, the reading is less important I think. But subtle changes in cadence and pitch do well to distinguish other voices.

Was this a book you wanted to listen to all in one sitting?

I probably would have had I had the time.

Any additional comments?

I (and other members of my family) have been a victim of over-diagnosis and allowed myself to by bullied and guilted into invasive advanced testing and treatment, all resulting in no change to my 'abnormal' test results... Until finally I said 'no more'. That was 34 years ago and the only time I have seen a doctor since then is for major injuries. I have no symptoms (except for the occasional and expected mid-60's aches). I take no medication of any kind and spend 2.5 to 4 hours in the gym 7 days a week. The only problem I have ever had was actually with doctors who refused to treat me because I wouldn't allow them to administer tests. They all said it was to reduce their liability. That's just NUTS and Dr. Welch addresses this in the book. I understand things like requiring an HIV test prior to surgery for safety, but when I broke my wrist, the Dr., for some reason, felt he needed to know when my last mammogram was. When I told him 1979 he felt compelled to ask me of I 'hated' myself. Now when asked these idiotic questions, I simply say it's irrelevant to this situation and none of their business. And you know what? If I get cancer I will not treat it. If I die, I die. I'll play those odds.

A must for every physician !

I enjoyed very much listening to "over-diagnosed".. I consolidated a lot of my past medical knowledge and learnt much more of new knowledge and practice points.. Regardless, one would agree fully or partly with the authors' principles, I urge, with no hesitation , every physician to read 'or listen; to this 'audio' book.

Very informative!

This book will help you become a more informed consumer of healthcare, and make you realize that more isn't necessarily better. This is a well balanced and intelligent discussion of the various medical screening and diagnostic tools that many of us will encounter. The narration keeps your attention, and the subject matter is substantial without becoming overly technical or burdensome.

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.

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.