Book Review: “Over-diagnosed” by Dr. H Gilbert Welch and others

Tuesday, October 4th, 2011 at 6:35 am

A couple years ago, I wrote about my personal weight loss crisis. I’d lost weight and everyone was noticing it and congratulating me. Problem was, I was arguably at a healthier weight pre-loss than I was after losing (since lowest mortality is at a BMI of around 24).

I described how health promotion watchdogs kept lowering the BMI limit for “overweight”, capturing more and more people under the “overweight” term with little evidence that those people were actually at increased risk.

As a result, all sorts of people who were once considered to be at a healthy weight, were now labeled as overweight. And they were told that overweight puts them at risk for diabetes, heart disease, cancer, etc. Problem is, the newly diagnosed individuals (with BMIs between the new “overweight” limit and the old one) aren’t necessarily at higher risk. They’re just now being lumped with those who are at higher risk.

These people are the “overdiagnosed”. They receive a diagnosis for a “disease” that has not harmed them and perhaps never will.

Over-diagnosedDoctors H Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin address this problem in their book Over-diagnosed: Making People Sick in the Pursuit of Health.

The authors discuss multiple areas of medicine where the pursuit of early detection of disease has led to people being diagnosed with potential problems that haven’t yet caused them real problems (and maybe never will). Then, once a “disease” has been diagnosed, treatment begins.

If the treatment were only beneficial and had no side effects, this might be fine. Everyone would be undergoing treatment for all of their potential problems and their potential problems would never develop into real problems.

But that isn’t the case. Instead, each of these treatments has a variety of side effects-some quite dangerous. If someone actually has a problem (that is causing them a problem), the positives in increased life expectancy or absence of disease symptoms outweigh the negative side effects. But for the overdiagnosed, the people who are diagnosed with a potential problem that is destined to never become an actual problem, the side effects are the only effects–since they will not be helped by the treatment (for a disease they don’t actually have, or don’t actually have a problem with.)

Packed with good scientific explanations, this book makes a strong case for opting out of unnecessary tests–and for asking more questions prior to beginning treatment.

This is not an anti-medicine book. The authors are all Western medical doctors who believe in evidence-based care. But they question whether the ballooning spate of over-diagnosis is really evidenced-based care or whether it’s fear-based care.

This isn’t the easiest book to read (it can get fairly technical at times), but I think it provides some very important perspective that is rarely offered in today’s medical and health-promotion arenas.

I have read a couple of articles which referenced overdiagnosis recently. The first, regarding mammograms and mastectomies stated the following:

“While scientists did not investigate why mastectomy rates climbed in screened groups, study author Pal Suhrke said the main reason is likely “cancer overdiagnosis,” or the detection and subsequent treatment of tumors that might grow very slowly and not pose much of a risk.”

The second, detailing the results of a physician survey, stated that almost half of all doctors in the US feel that their own patients are overtreated.

Rating: 4 Stars
Category:Consumer Health
Synopsis: The authors describe over-diagnosis and the dangers associated with routinely testing healthy individuals.
Recommendation: The health-savvy consumer will definitely want to read this.

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Reader Comments (7):

  1. This sounds like a much-needed book in today’s world! I get told every time I go to the doctor that I’m at risk for many things. But this list usually comes post-pregnancy at the six week check-up when I’m still recovering from a c-section. Of COURSE I’m not at my “ideal weight” then. I just had a baby for goodness sake. Suddenly I’m at a risk for diabetes and any other number of illnesses unless the weight comes over TOMORROW. Not that I wouldn’t wish for that. =) But I do think that my mental “healthy weight” places me in the overweight category for the most part.

  2. This sounds like a good resource, especially in the hands of someone like you who knows how to interpret it. I’m sure you see overdiagnoses a lot especially among the elderly. Even I have seen so many people get thrown pills to solve this or that problem, which then creates even bigger problems than the initial ones. It shows that we need to make wise and informed decisions about the choices we take (or not) in the name of good health.

  3. Barbara H. says:

    Sounds like a good resource. One of my qualifications of a good doctor is that they listen to me — one of my earliest doctors was very authoritarian and didn’t like it if I questioned or disagreed with him. Thankfully I only saw him when my regular dr. wasn’t available, and most of my doctors have been very good. Sometimes they’re quick to prescribe medicine, and I have to convey that the main reason I came in was not for medicine but just to find out what the problem was so I could make an informed decision. The procedure these days seems to be to go ahead and treat, and if that doesn’t take care of it they’ll investigate further.

  4. Janet says:

    This sounds really interesting.

    My grandfather was a doctor, and he was a gifted diagnostician. It was in the days before many of the tests and specialties were much less common, and he simply understood the human body in a comprehensive way — including the sometimes weird and unexpected interrelationships between different symptoms and systems. More tests and more specialization doesn’t substitute for a physician’s informed generalism and a switched on brain!

  5. Janet says:

    Oops — I meant in the days WHEN many of the tests and specialties were less common. :-)

  6. Sherry says:

    I’m not sure if I should read this book or not. I have a tendency to “under-diagnose”; I figure if I ignore symptoms they will eventually go away. And I don’t like to take medicine. However, sometimes IT, whatever IT is, doesn’t go away, and it would have been better to catch it sooner—like the time my two year old had pneumonia and I thought it was a cold that would go away. Trusting doctors is difficult because I do think they tend to over diagnose, but short of becoming a doctor myself, I don’t see what the options are.

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