Overdiagnosed

October 15, 2010

Three medical practitioners concerned about the impact of increased use of diagnostic screening tools address the underlying causes and present their prescription.

Welch, Schwartz and Woloshin—professors at the Dartmouth Institute for Health Policy and Clinical Practice—assert that too many Americans are receiving unnecessary treatment for so-called abnormalities that are prevalent in the population but cause no symptoms, and thus no harm. Due to the increased use of high-tech diagnostic tools and a corresponding lowering of diagnostic thresholds, more of us are being told we meet the criteria for conditions and diseases that warrant intervention. The authors recognize that they are presenting a tough platform—isn't it better, conventional wisdom states, to find and prevent high blood pressure or prostate cancer before actual onset of symptoms?—but their point is that it can be costly and even harmful. Potential problems become magnified, increasing numbers of people are labeled as patients and the side effects of many medications may generate more problems then they alleviate. Overdiagnosis leads to overtreatment, write the authors, who ask readers to look closely at claims that testing will save lives—e.g., "most women will not benefit from mammography—for example, about two thousand forty-year-old women need to be screened over ten years for one woman to benefit." The authors do a fine job incorporating relevant medical terminology to bolster their argument. However, because citing randomized trials and rational risk estimates doesn't hold great emotional weight, they also share their own common-sense observations as well as a body of research culled from many sources. The tone is sensible and serious but reassuring, and the authors make a strong case for moderation.

An antidote to alarmist thinking about the prevalence of disease.

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Starred review from November 15, 2010
Health policy expert Welchs assertions about the benefits of some of modern medicines most popular diagnostic screening tools are unlikely to ingratiate him with many people. He claims that overdiagnosis is the biggest problem posed by modern medicine, and backs that assertion up with a barrage of facts, charts, and graphs. This is information, he says, that is downplayed or simply ignored by individuals and groups promoting the notion that earlier diagnosiswhether for prostate cancer or diabetestranslates to better health. Indeed, Welch says, just the converse is more often true. In an overwhelming number of circumstances, early diagnosis turns healthy, asymptomatic people into patients who require a variety of medical interventions with no benefit, even exposing them to unnecessary harm. Worse, overdiagnosis can render perfectly healthy people uninsurable. Furthermore, instead of lowering health-care costs, all those scans, screenings, and tests actually raise costs by overtreating people who will never benefit from said treatment. His point is that both physicians and patients need to be skeptical and understand all the data (pro and con) surrounding prescreening for possible illness. Welch speaks his truth with a frankness and clarity scant found in todays hysteria over medical prescreening.(Reprinted with permission of Booklist, copyright 2010, American Library Association.)