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
"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)
A medical, scientific version of the old saw "if it ain't broke, don't fix it", and I applaud the exploration of current trends in testing and imaging of people previously considered "normal" and healthy and turning them into patients. The guidelines for abnormality are constantly shifting, mostly to the financial advantage of those involved in the health profession.
This is not a polemic against the use of doctors; just a warning to be a sceptic and be cautious in hopping on board the testing bandwagon and being turned into a patient, just another profit center for physicians, health facilities, imaging centers and health insurance companies. Of course, testing, scanning and other modalities can helpfully put an at-risk patient, someone in danger of incurring future serious negative health outcomes, into the domain of "healthy", but it's important to apply the brakes to the current trend in speed-testing an otherwise asymptomatic and a healthy individual.
The author also cautions against making use of the current genetic profiling technology in order to apprise oneself of any hereditary genes gone wrong. In this situation, perhaps, and only perhaps, some good can be achieved by knowing of a high percentage of likelihood for a smattering of seriously debilitating diseases which would have life-altering consequences both in terms of treatment and in terms of the disease itself.
I'd only agree with this position if no treatment was available to fix the genetic glitch, or remedy for the statistical probability of negative outcome. So, now that you know, but what can you do about it? In the case of breast and ovarian cancers, however, the answer to this question is...plenty!!!
With the ever-increasing knowledge of specific deleterious genetic information, and the identification of the genes BRAC 1 & 2, it is now possible to divert and indeed eliminate the occurrence of breast and ovarian cancer. Recurrence is always a consideration, but that could happen with or without surgical intervention. With an 87% of getting breast cancer and a 50% chance of getting ovarian cancer, an otherwise healthy individual with these genetic glitches cannot afford to "watch and wait"...to get cancer, in many cases.
The preventative surgeries for these diseases are not without risk and consequence in quality of life, especially for women of child-bearing age but additional interventions such as breast reconstruction (provided by health insurance) and assisted fertility in the case of prophylactic oophorectomy, can help mitigate the effects - such as sudden early menopause, loss of fertility, negative body image - that are concomitant with these procedures. In other words, you can have re-engineered breasts and can continue to bear children with banked embryos.
This is just to say there are situations where screening is helpful and though monitoring is inconvenient, it beats getting cancer.
On most points the book's general thesis is spot-on, and counters the myth that over-diagnosis, especially considering litigation, is always better. But is it really? In terms of accomplishing nothing in many case but initiating further testing and surgeries and resultant anxiety is it always helpful??
Above all do no harm. Just depends on how "harm" is defined.
Bookman Old Style
This book is one of the best nonfiction titles ever from Audible. It answers many questions I've had about why so many people seem to be sick, why health care costs have escalated beyond belief, and why so many people are frightened by their own bodies and subjected to endless psychological and physical invasions by the medical establishment..
So many memorable moments and the feeling of enlightenment was so strong I listened to the book twice, and have recommended it to everyone I know. I feel we all owe it to ourselves, friends, and family to incorporate this information into our knowledge base to better deal with our world today.
Couldn't possibly listen to it in one sitting, but it merits going back to again and again.
I was really beginning to wonder if I was the only person who thought cancer screenings were WAY over-done. So glad to know that I'm not! The author's offer some great information in this book and I would highly recommend it. While it is a book about medicine and statistical information, I felt the authors did a wonderful job of making the information easily digestible and interesting.
Now I need to arm myself for the inevitable battles I'm sure I will have with my own doctors when I tell them I will NOT be having all of these screenings they are trying to push on me.
Near the top. The material is covered extremely well, and with necessary but not overdone repetition Dr. Welch lays out his case in a convincing and caring manner. Many of us can find similarities between our own stories and those that are portrayed in the various anecdotes that are found throughout this book. We all should be concerned with the bottom line question - what if Dr. Welch is right? I believe that he is and I have recommended this book to friends and family. After listening I also bought the hard copy so that I can refer to it and present it to friends who needs to see tangible evidence.
Dr. Welch. I am very impressed with his analyses, compassion and humility.
I feel that Sean's voice is perfect for this role. He was exceptional in conveying the data - even the 'dry facts' - in a way that held my interest in even the smallest details.
Yes. I could not - but I devoured the book in record time nonetheless. I will probably listen to it again later this year.
Get it - read it - and get others to do the same.
I'll bet someone wrote a similar book about bloodletting two hundred years ago.
As a person with dyslexia, audio books give me the opportunity to "read" wonderful books that I would otherwise miss. Thank you for this fabulous service.
I have argued with my doctor for years. He thinks I should take cholesterol medications. I told him I don't want the side effects. He gave me a glucose monitor, I don't use it. His medical assistant thought I should be on Metformin for my "pre-diabetes." I said no. I'm not just stubborn. I saw the damage to my mother's quality of life caused by prescription drugs. I have several friends whose lives revolve around getting the right balance to the many drugs they take. I have worked seven years in a medical oncology clinic. (We give chemo.)
This book brought out points that I had not considered, but make perfect sense. I think everyone should read it, but it won't change anything. Too many people are eager to sue.
Over-Diagnosed is a brilliant (and very listenable) explanation of a very serious problem in modern medicine: the over-diagnosis of generally healthy patients. Dr. Welch explains how, and why, this is occurring. In the process, he provides, with remarkable clarity, why statistics thrown about by drug companies, illness-specific charities, and specialized medical societies are, at best, misleading and, at worst, deceptive. Once you have read (or listened to) this book, you will never again blindly agree to being tested simply because your doctor thinks it can't hurt. It can. The reader does an excellent job. Highly, highly recommended!
I agree with the author that overdiagnosis is a real problem that harms a good number of people, but I don't necessarily agree that the solution is to avoid diagnostic technology. The book is thoughtful and well constructed, that said, it is somewhat monotonous. It's a killer magazine article, but for the casual reader is a bit thin for for a book.
Say something about yourself!
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.
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.
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