From a nationally recognized expert, an exposé of the worst excesses
of our zeal for medical testing
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.
Drawing on twenty-five years of medical practice and research on the
effects of medical testing, Welch explains in a straightforward,
jargon-free style how the cutoffs for treating a person with abnormal
test results have been drastically lowered just when technological
advances have allowed us to see more and more abnormalities, many of
which will pose fewer health complications than the procedures that
ostensibly cure them. Citing studies that show that 10 percent of two
thousand healthy people were found to have had silent strokes, and that
well over half of men over age sixty have traces of prostate cancer but
no impairment, Welch reveals overdiagnosis to be rampant for numerous
conditions and diseases, including diabetes, high cholesterol,
osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as
well as skin, prostate, breast, and lung cancers.
With genetic and prenatal screening now common, patients are being
diagnosed not with disease but with pre-disease or for being at high
risk of developing disease. Revealing the economic and medical forces
that contribute to overdiagnosis, Welch makes a reasoned call for change
that would save us from countless unneeded surgeries, excessive worry,
and exorbitant costs, all while maintaining a balanced view of both the
potential benefits and harms of diagnosis. Drawing on data, clinical
studies, and anecdotes from his own practice, Welch builds a solid,
accessible case against the belief that more screening always improves
health care.
