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)

Agreed, Too Many Medical Interventions

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.

I am a victim

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.

A Must Read for All!

Where does Overdiagnosed rank among all the audiobooks you’ve listened to so far?

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..

What was one of the most memorable moments of Overdiagnosed?

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.

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

Couldn't possibly listen to it in one sitting, but it merits going back to again and again.

Bravo- someone has finally said it

I'll bet someone wrote a similar book about bloodletting two hundred years ago.

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.

Excellent book, revealing, unconventional approach

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

I would strongly reccommend it. This book presents an interesting view that is seemingly against "common wisdom" that early diagnosis and screening are always good.

Who was your favorite character and why?

I liked the author of the book and the way he presented his views

What about Sean Runnette’s performance did you like?

Very clear, not too fast which makes easier to grasp the facts. Overall one of best narrators so far

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

Life examples of individuals turned into patients and asymptomatic people harmed by tests

Any additional comments?

I liked this book very much because it was one of those few books that were able to change my thinking about the world.

Great Information

Any additional comments?

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.

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.

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.

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.

Thought Provoking

A very interesting take on the question of testing for disease and disease prevention looking at both risk and reward.