Overdiagnosed: Making People Sick in the Pursuit of Health
Sunday, April 17th, 2011Is it possible that doctors, hospitals, clinics — the whole health care industry — are driving up the cost of health insurance and care by over-diagnosing ; that they are creating more patients who might never have needed to see a doctor or have an expensive battery of tests; that by conducting wholesale screenings of healthy men and women they are harming more people than are helped?
If you had asked me those questions a few weeks ago, I might have laughed. Everyone knows the purpose of health screening for diseases like high blood pressure and cancer is to find problems before they get bad so they can be treated and lives will be saved. How can that be bad?
But what if screening is “catching” conditions that would never have posed any problem for the patient? What if treating with medication an otherwise healthy man with no symptoms or complaints simply because a screening revealed his blood pressure was slightly elevated leads to a broken neck after the meds cause his blood pressure to drop too low and he passes out while driving?
I just finished reading Overdiagnosed: Making People Sick in the Pursuit of Health, in which Dr Gilbert Welch along with co-authors Dr. Lisa Schwartz and Dr. Steve Woloshin make the case that we are doing just that — that screenings and overdiagnosis may be leading to more harm than good while driving up health care costs.
Dr. Welch writes:
“I believe overdiagnosis is the biggest problem posed by modern medicine.”
“It has led millions of people to become patients unnecessarily, to be made anxious about their health, to be treated needlessly, and to bear the inconvenience and financial burdens associated with overdiagnosis. It has added staggering costs to our already overburdened health care system. And all of the forces that helped create and exacerbate the problem – financial gain, true belief, legal concerns, media messages, and self-reinforcing cycles – are power obstacles to fixing it.”
In the book, Dr. Welch explains how committees and boards change numbers resulting in previously healthy people being classified as having diabetes, high cholesterol, and osteoporosis leading their doctors to recommend treatment that often includes a lifetime of taking expensive medication.
He shows how screenings find blood clots, gallstones, bulging discs, abdominal aortic aneurysms and damaged knee cartilage you never knew you had and which would probably never have bothered you and how genetic testing can brand you with almost anything.
He details how overdiagnosis of prostate, breast, thyroid and other cancers can lead to harming otherwise healthy people.
By the time you finish the book you’ll understand not only why screenings and over diagnosis are generally bad, but why it happens and why nothing has been done about it so far.
If you’ve ever considered full-body scans or other screenings, if your doctor routinely orders lots of tests even though you feel well, or if you just want to arm yourself with a healthy dose of skepticism to take with you to your next physical, you will want to read this book.
I learned a lot from Overdiagnosed. You will, too.
The book should be available in most libraries, although its popularity means you might have to get on a list and wait awhile.
If you prefer to buy it so you can pass it around to relatives and friends when you’re done, you can get it at Amazon for $13.86 and if you use this link
Overdiagnosed: Making People Sick in the Pursuit of Health
Dr. H. Gilbert Welch, Dr. Lisa Schwartz, and Dr. Steve Woloshin
Beacon Press, 248 pages, List price: $24.95
April 17th, 2011
Just like insisting that the doctors make you well when you go in with a cold and demand antibiotics. It is so much better to go to a medical doctor only if you’re feeling unwell.
April 17th, 2011
It’s not so much overdiagnosis as misdiagnosis. Treating symptoms instead of causes. High cholesterol is caused by the body trying to patch up inflammation but instead of treating the cause, inflammation, they give you pills in perpetuity for cholesterol. They give children amphetamines (Adderall) for ADHD instead of removing the petrochemical food additives that are causing the bulk of the problem in the first place. Federal nutrition guidelines, emphasizing inflammatory grains and carbs and discouraging meat and fat, and federal farm subsidies that complement those incorrect guidelines do tremendous damage. Read “The Paleo Solution”, “Primal Blueprint”, feingold.org, etc.
April 17th, 2011
We can opine and debate in type for hours. The quickest answer for this debate is for the patient-consumer to become more savvy about their own health management. While an abdominal aorta can prove catastrophic if it becomes too large (with little time to manage when ruptured), you DON’T need antibiotics for a cold. If you are reading this at Backwoods Home, you probably already taking charge of your health management. Become familiar with the Patient’s Bill of Rights and make it work for you.
Further examination re: increased costs and overdiagnosis will reveal the usual culprits ……A consumer public willing to: accept suggestions from Pharma to ask for medications they may not need; sue (with the help of ambulance chasing lawyers) an otherwise reputable doctor when the tragic and unfortunate happens OUTSIDE of blatant malpractice. Add to that the good doctors forced to over-test to prevent being sued. Finally, the third-party payer insurance system in its current state. Makings of an expensive chicken soup difficult to swallow.
We have well-intentioned and skillful physicians, lawyers that fight the good fight, and pharmaceutical companies that develop the treatments to fight cancers, aids and more. We don’t have the time and means to all become doctors, but knowing our rights as patients, learning to ask questions, knowing when accept or decline certain testing, and taking a few minutes with reputable medical literature certainly won’t hurt.
April 17th, 2011
Over-diagnosis, mis-diagnosis, the doctor covering his assets in case something is missed and a malpractice suit brought — I believe all these and other factors are in play. My wife was put on meds to treat hypertension — and normal-for-her is around 115/60. HOW is that high?? She passed out or just “went down” several times until I could convince her to quit taking the pills; she kept saying “The doctor is the professional (or the expert), I’m paying him to know what he’s doing.”
I’ve been subjected to the SAME test 4 times in 3 months because the lab supposedly sent paperwork to my GYN with results, but the doctor supposedly never saw it. The paperwork mysteriously appeared when I stated I would not pay nor ask my insurance to pay for another test and would refuse further tests. That’s when the results showed up in my chart and the GYN started pushing for surgery — as it was elective I weighed the risks and refused. As the tests were part of a routine exam and I have been asymptomatic for the condition they were testing for, I feel I made the right choice.
I go to the doctor if I am certain I need antibiotics and the home remedies I use haven’t made a dent OR if there is an actual physical issue (such as a hernia I had repaired a few years ago).
Too many pills, too many tests, too much fear-mongering and WAY too many people who refuse to take responsibility for their own bodies.
Deification of doctors. Laws backing the big labs. Unjustified malpractice suits. (Yes, SOME are justified. In my opinion, many more are not.)
April 17th, 2011
And when they aren’t selling enough of some of the more common drugs, they just tighten up what is considered normal. Part of the “obesity epidemic” has simply been caused by a lowering of what BMI (a truly useless metric, btw) is considered “obese”. The numbers at which cholesterol, blood pressure, and blood glucose are considered “too high” have all been decreased in the past decade or so, with the scientific evidence backing up the change being shaky at best…but it sells lots more meds.
April 17th, 2011
Do you want to shock your medical care provider? Ask them if you will get better without the meds. I had an awesome doctor in another state and he was taken back when I asked that and he told me that I was the only patience that had ever asked him. I hate taking drugs into my body and he was willing to work with me. It was great.
April 18th, 2011
I had an elderly neighbor who was very poor. Someone helped her get on indigent insurance and all of sudden she was told she had breast cancer. I went to the doctor with her one time and she was told she needed a lumpectomy and wouldn’t need chemo or radiation. She told the doctor that she wasn’t sick until she came to see him. After the lumpectomy they did chemo and radiation and she takes lot so pills now that cause her to cough really bad. The did a colonoscopy that was perfectly clear. But since then she mysteriously got colon cancer and had surgery for that. The problem is that modern medicine is a false god. People believe doctors as if they are gods. The pharmaceutical companies give medicines just in case. I know another elderly lady who takes statin drugs just in case she has a colesterol problem. Those drugs are known to destroy the liver.
April 18th, 2011
This is not exactly on the subject, but is related — an interesting article re: doctors’ decisions.
“But in tough situations, “it might not be fair to lay out the a la carte options and leave it to the patients” to decide, said editorial co-author Dr. Roshni Guerry.”
It IS the patient’s decision to make — but what’s not fair is that patients don’t always get complete information and choices before they have to make the decision. They’re often told what the preferred or conventional choice in the medical field is, or what the doctor wants or is capable of doing.
April 18th, 2011
This is on my library list now, thank you.
April 23rd, 2011
While we may be overdiagnosed, we as a society seek overdiagnosis and frequently when diagnosed it is a crap shoot whether they (doctors) even get the diagnosis right.
My goal in life is to minimize my visits to the doctor and to at all costs avoid invasive procedures, including central line tubes AND stay out of the hospital. Health care can make you well, but it can also kill you.
While doctors contribute to the outrageousness of healthcare costs, we as consumers are also guilty seeking care at the drop of a hat. A lot of tests are ordered just to cover the doctors in case of misdiagnosis and lawsuit.