Name: Overdiagnosed
ISBN: 9780807022009

Overdiagnosed

After the criteria used to define osteoporosis were altered, seven million American women were turned into patients-literally overnight. The proliferation of fetal monitoring in the 1970s was associated with a 66 percent increase in the number of women told they needed emergency C-sections, but it did not affect how often babies needed intensive care-or the frequency of infant death. The introduction of prostate cancer screening resulted in over a million additional American men being told they have prostate cancer, and while studies disagree on the question of whether a few have been helped-there's no disagreement that most have been treated for a disease that was never going to bother them. As a society consumed by technological advances and scientific breakthroughs, we have narrowed the definition of normal and increasingly are turning more and more people into patients. Diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades, while the number of deaths from those diseases has been largely unaffected. Drawing on twenty-five years of medical practice and research, Dr. H. Gilbert Welch and his colleagues, Dr. Lisa M. Schwartz and Dr.

What Hacker News says

asturaNov 2017

The "annual physical" is not evidence based. It might seem to "make sense," however, that's not how science works.

Not only that but there's no such thing as "routine bloods." The reason I say that is because 1) to my knowledge there's no evidence based group that recommends any sort of blood test annually and 2)I have been to many GPs over my lifetime (~10?) and I was well into my 30s until I saw one that ordered routine bloodwork as a matter or course. All the ones before that just listened to my heart, took vitals, felt organs, etc. Then that doctor retired and I her replacement also ordered routine bloodwork. The two doctors differed greatly on which test they considered routine.

https://sciencebasedmedicine.org/re-thinking-the-annual-phys...

>Not too long ago, the “if it ain’t broke don’t fix it” mindset changed. It became customary for everyone to have a yearly checkup with a doctor even if they were feeling perfectly well. The doctor would look in your eyes, ears and mouth, listen to your heart and lungs with a stethoscope and poke and prod other parts of your anatomy. He would do several routine tests, perhaps a blood count, urinalysis, EKG, chest-x-ray and TB tine test. There was even an “executive physical” based on the concept that more is better if you can afford it. Perhaps the need for maintenance of cars had an influence: the annual physical was analogous to the 30,000 mile checkup on your vehicle. The assumption was that this process would find and fix any problems and insure that any disease process would be detected at an early stage where earlier treatment would improve final outcomes. It would keep your body running like a well-tuned engine and possibly save your life.

>We have gradually come to realize that the routine physical did little or nothing to improve health outcomes and was largely a waste of time and money. Today the emphasis is on identifying factors that can be altered to improve outcomes. We are even seeing articles in the popular press telling the public that no medical group advises annual checkups for healthy adults. If patients see their doctor only when they have symptoms, the doctor can take advantage of those visits to update vaccinations and any indicated screening tests.

>The physical exam of a healthy, asymptomatic adult is unlikely to reveal any significant abnormality (1) that would not have been detected eventually when symptoms developed and (2) whose earlier detection and treatment would reduce morbidity and mortality in the long run.

>A directed physical exam is sometimes indicated in patients with risk factors for specific conditions. A Pap smear is indicated in most women, but not every year, and the accompanying pelvic exam is likely a waste of time.

>For healthy adults between the ages of 18 and 65, The American Academy of Family Physicians (AAFP) recommends only these components of the traditional physical exam:

>For men, a blood pressure measurement. >For women, a blood pressure measurement and a periodic Pap smear.

>They have other recommendations including vaccinations, counseling, and screening tests; but none of those require a physical exam.

>There is a general perception, among the public and among doctors, that there’s no such thing as a bad screening test, that early detection is important, that knowing is always better than not knowing. If something is wrong with you, you need to know because, if you find a problem in time, it can be treated effectively to prevent morbidity and mortality. If you get a checkup and everything looks OK, you can breathe a sigh of relief and relax. Unfortunately this is all wrong.

>A recent book explains why: Overdiagnosed: Making People Sick in the Pursuit of Health, by Drs. H. Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin. It’s a comprehensive explanation of how test results make people sick and why visiting a doctor can be hazardous to your health.

>For a healthy, asymptomatic patient, the physical exam with the laying on of hands and stethoscope and other rituals is pretty much meaningless. If nothing is found, it can produce false reassurance. If something is found, it is not likely to prolong the patient’s life and it has a significant likelihood of leading to harm from unnecessary treatment or from a diagnostic cascade of tests, unnecessary surgeries, unnecessary expense, and unnecessary worry.

https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

https://sciencebasedmedicine.org/overdiagnosis/

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kgwgkDec 2014

> False positives aren't inherently a problem. If you have accurate understanding of the sensitivity and specificity of a test, then you can take action to maximise the utility of the expected outcome.

In many cases, the optimal action is not to test in the first place. "Overdiagnosed" is an interesting book on the subject by Dr. H. Gilbert Welch. A recent piece by him in the NYT gives an idea of his thesis: http://www.nytimes.com/2014/11/06/opinion/an-epidemic-of-thy...

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awakeasleepMar 2012

If you're interested in how our ability to detect cancers (and other diseases like diabetes and osteoporosis) has surged ahead of our ability to know when treatment is effective, I highly recommend Overdiagnosed by Welch, Schwartz, and Woloshin.

Right now medical science seems to be at an uncomfortable phase with certain diseases where we can't be sure our treatments will have a greater benefit than the cost of the treatments— and not just in terms of price, but at the expense of our health itself.

http://www.amazon.com/Overdiagnosed-Making-People-Pursuit-He...

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