Mar 17, 2011

BkRev: "Over-Diagnosed" by Dr. H. Gilbert Welch

H. Gilbert Welch, MD, Lisa Schwartz, MD, and Steven Woloshin, MD, Over-Diagnosed: Making People Sick in the Pursuit of Health, Boston, Beacon Press, 2011, 228 pages.

"So when I suggest," writes Dr. Gilbert Welch, "that we develop a healthy skepticism about early diagnosis, I am referring specifically to seeking diagnoses in the absence of symptoms, because that's when overdiagnosis can occur. ... I'm simply suggesting that we should be most cautious about early diagnosis in those who feel well" (p. 185).

"Some," Dr. Welch continues, " may prefer to pursue health: to focus on feeling healthy and minimize medical contact while they are well. They accept a slightly higher chance of death or disability to minimize the chance of medicalization, overdiagnosis, and overtreatment now. They prefer to reserve medical care for problems that are obvious to them. Others may want to pursue disease: do everything they can to be healthy in the future and to decrease their chances of experiencing death or disability -- even with the knowledge that they are more likely to be diagnosed with disease, more likely to be frequently exposed to medical care, and more likely to suffer harm" (p. 185)

Those two basic choices -- primarily pursue health or primarily pursue disease -- are the alternatives the author of Over-Diagnosed offers at the end of his book. To reach that end, the author clearly but in considerable detail examines the potential benefits and dangers of premature diagnosis, that is, diagnosis formed before symptoms lead a patient to seek a solution to emerging problems.

The author explains the principles of diagnosis and overdiagnosis as he proceeds through a list of common diseases that most people -- and usually their doctors -- fear enough to be medically tested even before symptoms of disease appear. Those common diseases are: diabetes, osteoporosis, gallstones, damaged knee cartilage, bulging discs, abdominal aortic aneurysms, blood clots, defective pregnancies, prostate cancer, breast cancer, and other cancers. He also considers markers which are not themselves diseases but which might be harbingers of later disease: high blood pressure, high cholesterol, and genetic defects.

Welch meticulously shows the dangers of screening, that is, of automatically testing everyone -- or at least everyone of a certain category -- for the presence of a disease, even if they have no symptoms. The evidence for and against screening or other forms of premature diagnoses is mixed, which is why making a decision is difficult -- as much for physicians as for patients.

The time to read this thoroughly documented book is now, not when a physician tells you that you should be screened periodically for disease X or that you "might" have cancer or other frightening disease. Then you can make your choice about which approach you want to take.

Burgess Laughlin
Author, The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reasn vs. Faith,

1 comment:

Burgess Laughlin said...

Dr. John McDougall here discusses a case of probably correct diagnosis but over-treatment recommended by a surgeon, that is, radical and aggressive treatment not justified by scientific studies:

"How to Protect Yourself from Abusive Medical Doctors"

October 2011 McDougall Newsletter