February 28, 2011

Overdiagnosed: Making People Sick In The Pursuit of Health

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“I believe overdiagnosis is the biggest problem posed by modern medicine,” writes Dr. Gil Welch in his new book, “Overdiagnosed: Making People Sick In The Pursuit of Health,” which he coauthored with Drs. Lisa Schwartz and Steve Woloshin.

Welch continues:

“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.”

The book hits on these themes:

* how numbers get changed to give you diabetes, high cholesterol and osteoporosis;
* how scans give you gallstones, damaged knee cartilage, bulging discs, abdominal aortic aneurysms and blood clots;
* overdiagnosis of prostate cancer, breast cancer and other cancers;
* stumbling onto “incidentalomas that might be cancer”
* how genetic testing will give you almost anything;
* how screening gives you (and your baby) another set of problems.

Ray Moynihan reviewed the book in the BMJ. Excerpt:

“A key theme here is the need to get better, clearer information to people–to get closer to the truth of the uncertainties around early detection and the potential harms of unnecessary treatment. Unlike so much promotion that passes for medical journalism, Over-diagnosed features success stories of patients who have explored the uncertainties and opted not to accept potentially unnecessary treatments.

Building processes for mandatory and meaningful informed consent into the very infrastructure of medicine could be a big win for people who don’t want to become patients needlessly–but will likely mean a rather large loss for those who benefit from treating them.”

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