Overdiagnosed: Making People Sick in the Pursuit of Health

I believe this book should be compulsory reading for al ldoctors so that they stop and think carefully before automatically reaching for their prescription pad "Does this person really need this? Am I going to prescrible this or that medication as a knee jerk reaction because that's what I always do?" Prospective "patients" - and it's obvious from this book that we're all prospective "patients" - should also read it and be aware that the doctor's not always right. I have personal experience of a doctor suddenly insisting that I had hypertension.I ended up taking pills unnecessarily for six months until one day I came to my senses, stopped wandering around like a zombie and having near misses when I was driving, bought a blood pressure meter and found that in fact I had normal blood pressure. I found a more trustworthy doctor who gave me several tests to make sure I didn't have hypertension. But what would have happened if I hadn't seen the light? And what about all the other people who are being prescribed various pills and lotions unnecessarily? Apart from being quite an eyeopener for everyone, this book is written in such a clear and interesting way that it's hard to put down. I originaally got it as an e-book but because the diagrams didn't show up as well on the electronic screen, I bought the actual book and everyone in the family's reading it after which it'll be passed on to all our friends.

An excellent book dealing with a very important issue for modern society. Thoughtful people should read this book and consider the arguments before going down the path of frequent medical screening. The author is a senior medical professional and the book had a clear message and argument without being 'preachy' and handled medical evidence and reports carefully leading to very thought-provoking conclusions.

If it's true that patients put their GP's under pressure for a diagnosis and medication to sort it out, then what is the reasoning behind a six year (minimum), medical training? GP's are being directed more than ever to provide a solution for all of life's hardships. Solutions that is in a bottle to be taken as directed. This text is intelligent, insightful and witty, delivering its message that we are being over-medicated for a number of reasons. Some of it may be the patient's need for reassurance; another that the doctor has the need to 'do' something tangible to quell their patient's fears; or it may be that the drugs rep has suggested a brand new medication that has had rave reviews in several teaching hospitals and peer-reviewed journals. Really good read!

An essential read for everyone.

A really informative book, full of evidence for what is being told. The sort of book you can dip into and read up on whatever is interesting you at the moment. I bet it is hated by some members of the medical fraternity but that is tough. We have a right to know the facts before making decisions that are right for us. Highly recommended.

Very easy to read, excellent points about the harms of over diagnosis and over treatment. A bit Americanized but lays out the evidence very clearly. A must read for primary care doctors.

Everyone should read this though-provoking book. Members of the medical profession should read this book and ensure all patients are fully advised of any potential significant risks associated with any proposed treatment . The book should be compulsory reading for all medical students.

Brilliant exposure of how we doctors have succeeded in making people with the greatest life expectancy in the history of mankind feel ill and at risk of health disasters. Of course the book also exposes the Big Pharma companies and politicians. Every doctor and medical student should read this book. Once finished move onto "Intelligent Kindness'

The subject is much more complex than I thought . But the author doesn't hesitate to come back at length to reinforce or understanding , and while it could feel tiresome , it is in fact necessary to understand the self-reinforcing nature of overdiagnosis . Very good and intelligent book , but hard to summarize . Because ..... The subject is rather counter-intuitive . Reading it 10 years after publication, it allowed me to understand a bit better our new covid era , were you are deemed to be sick after a pcr test , even if you feel perfectly fine - while in fact you just may be potentialy contagious ( which is enough to incite you to stay at home )

The book shows how image scans and other health tests may create healthy patients with the sole purpose of making money. PSA low limits will induce unnecessary prostate biopsies, excess RMI may lead to useless and risky surgeries. A must read for doctors and patients as well.

This book will probably appeal to people like me, who have already been questioning the value of endless screening tests, but I hope others will read it as well. It is a large dose of sanity in the face of all the pressure from doctors, advocacy groups for various diseases, public service ads and commercials from companies offering screening tests who tell us we need to be screened because "early detection saves lives." Usually they throw in some stories of people who got screened, got treated and are still alive. They are all quoted saying "Early detection saved my life." But did it? Or did it just turn them into patients years before their "disease" would have manifested itself? Worse yet, maybe that tiny growth detected on the X-ray would NEVER have turned into actual disease. In that case, they did not need any treatment and may have been harmed by the treatment they received. Dr. Welch calls this "overdiagnosis." Dr. Welch points out that these "success" stories lead to more screening which leads to more useless treatment. Proponents often cite the increased "cure" rate of those who are screened versus those who are not. Logically, the time between diagnosis and the time when the patient is considered "cured" (say, five years with no recurrence) will be greater if a tumor was found several years before it would have manifested as symptoms. With or without screening, a tumor would grow (or not grow) at the same rate. Without screening, a tumor that grows will be discovered when the patient has symptoms. That's a later diagnosis, but the course of the disease is the same and early treatment might make no difference at all. MY MAMMOGRAM STORY I am in my middle 60s and had always resisted getting a mammogram until recently. I had changed doctors and my new doctor gave me a referral and I decided to do it this time. I think it was mostly out of curiosity and because Medicare would pay for it (a wrong reason, I know!). The screening was done at a huge hospital complex (Beaumont Hospital in Royal Oak Michigan). The procedure was fast and not too unpleasant, but I was surprised to get a phone call a few days later telling me I needed to make another appointment for more views. I asked why and got no real answer, other than the Radiologist wants more views. I said I needed more information before I would come back and they said to call my doctor. I did that, and his staff person had to search for any information about my mammogram, but finally found what the hospital had sent and it merely said that the results were inconclusive for the left breast. This does not tell me what was inconclusive. I then received a letter from the hospital, which said the initial findings showed "a need for additional imaging studies, such as additional mammographic views, ultrasound or MRI for a complete evaluation." This sounded to me like the start of a cascade of expensive and possibly invasive and dangerous services which I did not want. I got several more calls from the hospital urging me to make another appointment, but I was not satisfied with the lack of real information as to why I should do that. Finally another woman called me who would only say she was "Sharon," so I don't know her position, but she must have been a supervisor because she did tell me more (there was an "asymmetrical density " in the left breast), but would not name the Radiologist (I later got her name from my Medicare payment info online). Sharon said (in effect) I was likely called back because this was my first and only mammogram and they had nothing to compare it with. I subsequently received a certified letter from the hospital, which I take to be their "CYA" letter in case I turn up with cancer and sue them. I finally sent them my own certified letter explaining why I was not returning and asking for access to the images and notes from my mammogram. They have never responded. I do breast self-exam and there are no lumps or any abnormality. I have no symptoms and I feel fine. I am more willing to trust my own instincts that I do not have brest cancer than I am willing to trust the people at the hospital. My only regret is getting the mammogram in the first place. To hear all the hype about mammograms, you'd think they somehow PREVENTED cancer, whereas they do no such thing. They are X-rays of the breast and the "findings" are the opinion of a Radiologist who does not see you or examine you. I find Radiology a strange kind of medical specialty. It does not involve patient contact, but is based on a person (presumably the Radiologist) studying images and coming to a conclusion. In the book, Dr. Welch has a horrific story of a pregnant lady whose imaging screening could not image one of her baby's feet. The Radiologist decided the baby probably had a club foot. The poor mother-to-be drove herself crazy learning all about club feet and imagining what life would be like for her deformed child. When the baby was born, both feet were perfect. The point is, these images are often going to find anomalies that can't be definitively said to be deformity or disease. But the findings WILL lead to a lot more medical services. I think Dr. Welch actually underestimates one of the consequences of this and that is the expense. Whether it's the patient paying (increasingly the case) or insurance or Medicare, screening leads to a lot of expensive services that are not needed and can do a lot of harm. Men treated for early signs of prostate cancer can become permanently impotent, and the worst of it is their prostate cancer may never have progressed to a point where they would have symptoms. Many men with prostate cancer eventually die of something else because the cancer is so slow growing, or may not grow at all. Particularly with prostate and breast cancers, studies involving autopsies show many people have small cancers they never knew they had and which never caused any symptoms. Dr. Welch works for the VA, which is a single-payer government-funded system in which the doctors have no financial incentive for overtreating patients, but I think lots of doctors are biased in favor of treatment when it may not be needed because of the extra income it brings. Radiologists who don't even see the patient have every incentive to say they "need more views." The hospital has every incentive to encourage women to come for mammograms, then to do more imaging if anything at all is found on the screening X-rays. Dr. Welch also barely mentions the fact that X-rays CAUSE cancer! Yes, we've all heard about how tiny and harmless those doses are in a mammogram or other X-ray, but the effect is cumulative. That is one reason I was not eager to "have more views" taken. When those dose amounts in a mammogram are mentioned, how many "views" are they based on? Why don't screening services release actual information of the dosage of each view? How do I know their machines are working properly or that their technicians are competent? Why should I trust these medical providers on this subject when they have so much incentive to encourage "more views?" Too much worrying about our health and visiting doctors when we are not sick is adding to our bloated health care bill in the US. Maybe we should just accept our own mortality and not seek ever-more information from inside our bodies via screening. People talk about the supposed benefit of finding disease early, but never about the harm of pursuing tiny ambiguous anomalies leading to treatment that could be unnecessary and surely is expensive. This book is very well-written, with clear explanations, nice graphs to help illustrate the points made, and plenty of eye-popping examples. Before you buy in to "early diagnosis" and give into the pressure to get screened, read this book and use your head. Dr. Welch makes his case.

An honest book on medical practice

La experiencia te dice que Gilbert Welch tiene absoluta razón. Es una pena que en España (ni en el resto del mundo) no haya debate sobre esta cuestión. Máxime cuando el impacto del sobrediagnóstico en la población y en los presupuestos del Estado es tan importante. Es un libro que hay que leer.