OVER-DIAGNOSIS MAKES PEOPLE SICK IN THE PURSUIT OF HEALTH

From healthism to overdiagnosis

Free download and borrow the book here

Dr. H. Gilbert Welch has written a new book Over-diagnosed: Making People Sick in the Pursuit of Health, with co-authors Lisa Schwartz and Steven Woloshin. It identifies a serious problem, debunks medical misconceptions and contains words of wisdom.

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.

We are healthier, but we are increasingly being told we are sick. We are labeled with diagnoses that may not mean anything to our health. People used to go to the doctor when they were sick, and diagnoses were based on symptoms. Today diagnoses are increasingly made on the basis of detected abnormalities in people who have no symptoms and might never have developed them. Overdiagnosis constitutes one of the biggest problems in modern medicine. Welch explains why and calls for a new paradigm to correct the problem.

Over the past several decades, there has been a growing enthusiasm for early diagnosis – engaging many physicians in a systematic search for abnormalities in people who are well. Partly as a result, diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet many of the individuals given these diagnoses never develop the symptoms from their conditions. They are overdiagnosed. And, while overdiagnosed patients cannot benefit from treatments for these conditions – there is nothing to treat – the treatments themselves can be harmful to them. Because of this it is critical to understand the trade-offs between diagnosis and over-treatment, and to be sure that health care systems don’t narrow the definition of normal so that – ironically – people are needlessly turned into patients and subjected to treatments that do harm instead of good. The lecture will discuss the definition of overdiagnosis – the detection of an “abnormality” that would have otherwise never become evident during an individual’s lifetime. It will describe the proximate mechanisms for overdiagnosis in current medical practice, such as changing rules, seeing more, looking harder, and tumbling onto things. It will explore the evidence for overdiagnosis and its harms. And it will consider approaches to mitigate the problem.

A paradigm shift is needed, but it will be difficult to achieve for many reasons:

It is hard to ignore information.
Most people believe the more information, the better.
Accepted wisdom and common sense are hard to overturn.
Most people are convinced that it is always in people’s interest to detect health problems early, even though the data say otherwise.
There is a common belief that early detection is cost-effective, even though the data show it actually ends up costing more.
We find it hard to tolerate uncertainty.
Commercial interests benefit from screening and overdiagnosis.
Doctors fear being sued if they omit tests.
Anecdotes about lives saved are emotionally persuasive.

IT IS OUR JOB TO EDUCATE AND INFORM

Sometimes, people really do NOT want to be open to a new way of looking at something, and no amount of evidence will convince them otherwise. They are so committed to their world view, or to their interpretation of “the truth,” that they close off, shut down, cross their arms – and feel justified in their ignorance. I'm finally beginning to learn that when it comes to raising awareness about Health , it's our job to educate and inform. It's not our job to convince.