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Overdiagnosed [Kindle Edition]

H. Gilbert Welch , Lisa Schwartzl , Steve Woloshin
4.5 von 5 Sternen  Alle Rezensionen anzeigen (2 Kundenrezensionen)

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“Very insightful and engaging.”—Dennis Rosen, The Boston Globe

“One of the most important books about health care  in the last several years.”—Cato Institute 

"One of the big strengths of this relatively small book is that if you are inclined to ponder medicine's larger questions, you get to tour them all. What is health, really?... In the finite endeavor that is life, when is it permissible to stop preventing things? And if the big questions just make you itchy, you can concentrate on the numbers instead: The authors explain most of the important statistical concepts behind evidence-based medicine in about as friendly a way as you are likely to find."—Abigail Zuger, MD, The New York Times

"Overdiagnosed —albeit controversial—is a provocative, intellectually stimulating work. As such, all who are involved in health care, including physicians, allied health professionals, and all current or future patients, will be well served by reading and giving serious thought to the material presented."─ JAMA

“Everyone should read this book before going to the doctor! Welcome evidence that more testing and treatment is not always better.”─ Susan Love, MD, author of Dr. Susan Love’s Breast Book
“This book makes a compelling case against excessive medical screening and diagnostic testing in asymptomatic people. Its important but underappreciated message is delivered in a highly readable style. I recommend it enthusiastically for everyone.”─ Arnold S. Relman, MD, editor-in-chief emeritus, New England Journal of Medicine, and author of A Second Opinion: Rescuing America’s Health Care
“This stunning book will help you and your loved ones avoid the hazards of too much health care. Within just a few pages, you’ll be recommending it to family and friends, and, hopefully, your local physician. If every medical student read Overdiagnosed, there is little doubt that a safer, healthier world would be the result.”─ Ray Moynihan, conjoint lecturer at the University of Newcastle, visiting editor of the British Medical Journal, and author of Selling Sickness
“An ‘overdiagnosis’ is a label no one wants: it is worrisome, it augurs ‘overtreatment,’ and it has no potential for personal benefit. This elegant book forewarns you. It also teaches you how and why to ask, ‘Do I really need to know this?’ before agreeing to any diagnostic or screening test. A close read is good for your health.”─ Nortin M. Hadler, MD, professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill and author of Worried Sick and The Last Well Person
“We’ve all been made to believe that it is always in people’s best interest to try to detect health problems as early as possible. Dr. Welch explains, with gripping examples and ample evidence, how those who have been overdiagnosed cannot benefit from treatment; they can only be harmed. I hope this book will trigger a paradigm shift in the medical establishment’s thinking.” —Sidney Wolfe, MD, author of Worst Pills, Best Pills and editor of


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.


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1 von 1 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Ein MUSS 3. August 2012
Von Lucipher
Format:Taschenbuch|Verifizierter Kauf
Tolle Statistiken, die auch der medizinische und statistische Laie versteht. Man geht danach sicher nicht mehr wie ein Auto in ständige Inspektion und macht sich auch nicht mehr mit den ganzen Vorsorgeuntersuchungen psychisch fertig. Ich fand es nicht nur spannend und erkenntnisreich, sondern auch sehr beruhigend. Für Männer ist es sogar essentiell: es wird gezeigt, dass die Prostata-Vorsorgeuntersuchung in sehr vielen Fällen zu unnötigen Operationen und damit viel Leid, z.B. Inkontinenz und Impotenz führen. Also für alle Männer und natürlich Frauen, die ihre Männer lieben, ein absolutes Must Read. Gilt genauso für Frauen, die Klarheit haben wollen, was ihnen die Screenings wirklich bringen. Nur eine Statistik sei genannt - es braucht 10 Jahre Screening und 1000 Frauen, die sich einer Mammographie unterziehen über diese 10 Jahre, damit eine einzige (!!!) davon profitiert, im Sinne dass sie länger lebt als ohne. Wenn das kein Grund ist, dieses Buch zu lesen, weiss ich auch nicht weiter;-). Bleibt gesund und munter!
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1 von 1 Kunden fanden die folgende Rezension hilfreich
4.0 von 5 Sternen Sehr spannend 28. Juli 2012
Format:Taschenbuch|Verifizierter Kauf
Dieses Gebiet ist wirklich viel zu wenig untersucht. Der Autor macht von Anfang an klar, dass es hier nicht um Menschen mit Symptomen geht, sondern um gesunde, beschwerdefreie Menschen, welche sich durch wiederholte Untersuchungen eine lebensverlängernde Wirkung erhoffen. Es ist ein heikles Kapitel, denn aus der Sicht des Arztes, wie der Autor das gut beschreibt, besteht wirklich die Gefahr der Anzeige wegen Unterlassung, und nicht die der Überstrapazierung des Gesundheitswesens, um nichts zu verpassen. Es ist schon sehr vertrakt.
Dies hat der Autor wirklich gut dargestellt, ebenso die Schwierigkeit, auch für einen Mediziner, einen guten Mittelweg zu finden. Sehr lesenswert, regt zum Denken an, hinterlässt einen ob des allgegenwärtigen Druckes aber auch etwas hilflos.
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Die hilfreichsten Kundenrezensionen auf (beta) 4.8 von 5 Sternen  122 Rezensionen
144 von 145 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Good Insights - 22. Januar 2011
Von Loyd E. Eskildson - Veröffentlicht auf
Format:Gebundene Ausgabe
Conventional wisdom is that more diagnosis, especially early diagnosis, means better medical care. Reality, says Dr. Gilbert Welch - author of "Overdiagnosed," is that more diagnosis leads to excessive treatment that can harm patients, make healthy people feel less so and even cause depression, and add to escalating health care costs. In fact, physician Welch believes overdiagnosis is the biggest problem for modern medicine, and relevant to almost all medical conditions. Welch devotes most of his book to documenting his concerns via examples of early diagnosis efforts for hypertension, prostate cancer, breast cancer, etc. that caused patient problems.

Welch provides readers with four important and generalizable points. The first is that, while target guidelines are set by panels of experts, those experts bring with them biases and sometimes even monetary incentives from drug-makers, etc. Over the past decades many target levels have been changed (eg. blood pressure, cholesterol levels, PSA levels), dramatically increasing the number classified as having a particular condition. (Welch adds that prostate cancer can be found at any PSA level - about 8% for those with a PSA level of 1 or less, over 30% for those with a level exceeding 4; most are benign.)

The second is that treating those with eg. severe hypertension benefits those patients much more than treating those with very mild hypertension or 'prehypertension;' the result is treating those with lesser 'symptoms' can easily cause new problems that outweigh the value of the hypertension treatment.

The third is that Welch believes it is usually more important to treat those with disease symptoms (eg. pain) than those without. For example, almost 70% of men 60-69 have prostate cancer, as well as about 10% of those aged 20-29 - a large number are better left untreated because their particular cases involve a very slow-growing form and the side-effects of treatment outweigh the benefits. Welch also reports that a study of over 1,000 symptom-free people that underwent total-body CT screens found 86% had at least one detected abnormality, with an average of 2.8. Many of these abnormalities later disappear (some cancers disappear), while others grow very slowly, if at all. Providing unneeded treatment subjects patients to unneeded pain, risk of adverse outcomes (including death), and unneeded expense.

Examples: Welch cites the example of a mildly hypertensive older man that he treated; unfortunately, while shoveling snow the individual passed out from a combination of sweating and the diuretic prescribed for his high blood pressure. Welch discontinued the man's medication. Similarly, Dr. Welch treated a patient with mild diabetes - the result was she fainted from low blood sugar (the level fluctuates around a mean) while driving just after a meal and was severely injured in an accident. Dr. Welch discontinued her medication as well.

Meanwhile, at the same time that a number of target guidelines have been tightened, the availability and capability of scanning and other detection devices to find abnormalities has also increased. For example, since the early 1990s, Welch tells us that the Medicare per capita use of head scans has doubled, the rates of abdominal scans have tripled, chest scans quintupled, brain MRI rates quadrupled, etc. New biopsy methods for detecting prostate cancer (eg. sampling from 18 points rather than 12 or fewer) also increase the number of benign 'false-positive' diagnoses, probably much more so than true positives.

Why is there so much testing? Dr. Welch attributes it to well-meaning disease advocacy groups, testimonials (eg. ex-Senator Dole regarding his prostate cancer), quality-improvement efforts that include testing as one of their criteria, malpractice awards, hospital/specialist/drug company marketing (beware of these, says Welch), and honest disagreement over its value. He's also concerned about what lower-cost DNA testing will add to the overdiagnosis problem, contending that everyone's genes will reveal heightened susceptibility to some ailments and diseases, with little that can be done despite the knowledge. The author would probably also be concerned about new Medicare requirements to provide a battery of up to 45 medical tests ("The Wall Street Journal" - 1/18/2011). That article also reports that a "New England Journal of Medicine" review of hundreds of preventive-care studies showed that fewer than 20% saved money.

Bottom-Line: Dr. Welch raises an important topic for improving health care while reducing costs. His main recommendation, more data from clinical trials showing the outcomes of choosing one diagnosing standard/method over another, is important and appropriate.
56 von 57 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Very Important Read 31. Januar 2011
Von A. Langston - Veröffentlicht auf
Format:Gebundene Ausgabe|Verifizierter Kauf
Dr. Welch's book is important and a good read. He explains concepts clearly and thoroughly, and the topic is timely and important for Americans, both from a public health (and personal misery) standpoint, as well as a skyrocketing national medical costs standpoint.

I have worked in the medical field off and on over the years, and even worked on a prostate cancer project, so I already knew a fair bit about the prostate cancer screening/treatment debate. I learned even more from Dr. Welch.

One question that I have had for years, and that has never been answered to my satisfaction is:

If a person is being treated for cancer, and they die from the treatment (on the operating table, from the drugs/radiation, etc.), do they count in the "deaths from cancer" statistic? I personally have known many more people who died from the treatment itself than who died from the cancer, and yet that particular topic does not get addressed. Are death rates from prostate cancer (for instance) holding steady because the treatments don't work, or because men are dying from unnecessary treatment and that offsets the successful treatments? (I did notice that the death rates for prostate cancer went *up* with an increase in detection in the figure on page 56.)

Statistics are smoky, and it really helps to know more about the study design. Dr. Welch does a very good job of describing the various studies, and their flaws and strengths. I'm sure it is a huge hot potato to discuss death rates from treatment, but I would be very interested in seeing those numbers broken out.
56 von 59 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Buy one copy for yourself and another for your doctor 1. Februar 2011
Von Nancy Robertson - Veröffentlicht auf
Format:Gebundene Ausgabe
I read Overdiagnosed this morning, and I strongly urge you to read it, too. If you've ever wondered why our country's healthcare costs are skyrocketing even though our health outcomes lag behind the rest of the industrialized world, this book has the answers. We are overtested, overdiagnosed and overtreated. But sadly and paradoxically, this intensive use of "preventive" medicine has not improved our physical health or sense of well being -- it has diminished it.

Dr. Welch builds a strong case that Americans are overdiagnosed in a clear, concise and compelling way. He provides anecdotal accounts of people who were seriously harmed by the overzealous use of modern, high tech testing. And he backs these stories up with findings from landmark medical research studies. As we move from chapter to chapter and disease to disease, we see the same patterns emerge: thresholds for "illness" are lowered and suddenly tens of millions of people are diagnosed and treated for mild or nonexistent "diseases" that never would have harmed them.

Dr. Welch identifies the key players who brought American medicine to this sorry state -- big pharma and medical products manufacturers hungry to increase profits, doctors who order unnecessary tests to avoid malpractice lawsuits, and overzealous patient advocacy groups who press for action in the absence of any scientific evidence of improved outcomes.

Dr. Welch explains key concepts like "lag time bias" and "overtreatment bias" that enable you to see why the benefits of aggressive preventive medicine are far less than you have been led to believe. Once you understand terms like these, you will never again be swayed by misleading advertising or public health campaigns. Instead, you will be able to make decisions about your own health care in a rational, intelligent, and informed way.

In short, if you read one health related book this year, it should be "Overdiagnosed." Buy one copy for yourself and another for your doctor.
25 von 26 Kunden fanden die folgende Rezension hilfreich
4.0 von 5 Sternen Why Looking for Diseases in Seemingly Healthy People Often Doesn't Benefit Patients 12. März 2011
Von Meredith - Veröffentlicht auf
Format:Gebundene Ausgabe
Dr. H. Gilbert Welch challenges the standard practice of preventative testing that most patients would never think to question. He disputes the current belief that it's always desirable and beneficial to obsessively screen healthy people for potential illnesses and describes how actively pursuing illness can actually be harmful to the patient being tested.

Just why is it bad to discover that people have diseases they don't know about and that have yet to create any symptoms? A few reasons discussed in this book are:
1) The medical-industrial complex continually lowers the numbers to give people more diseases.
2) Treating patients on the mild or borderline end of the disease spectrum often causes more harm than good.
3) The side effects of the treatments for patients with mild to moderate forms of a disease can be worse (and cause more discomfort and disruption) than the actual disease especially if they are asymptomatic.
4) Most people have "abnormalities" that would never cause them problems and are only diagnosed thanks to advanced medical imagining.
5) There is the very real risk of false positives, causing patients to be treated for things such as prostate and thyroid cancer that they never actually had. This is not only expensive but can cause lasting harm in addition to the negative effects of the treatment.
6) Some abnormalities that are technically classified as cancers are genetically destined never to progress or cause a person symptoms.
7) Due a patient's age or other medical conditions, s/he will die of something else for the cancer progressed enough to cause symptoms or discomfort. So, diagnosing and treating them will not benefit the patient. In fact, it will only harm them emotionally, financially, and physically.
8) Rapid growing cancers that are also often resistant to treatment frequently are not caught by annual (or continual) preventive screenings because they develop so rapidly and can appear between screenings.
9) Actively searching for disease in asymptomatic patients further strains an already overburdened medical system.
10) The discovery of pre-existing conditions can result in the loss of medical insurance and the refusal for insurance companies to cover the costs of treatment.
11) The potential benefit of treatment commonly falls short of the actual benefit by a significant amount.
12) Many of the motives behind the push for preventative screens are not altruistic (i.e. motivating factors include profit and fear of lawsuits).
13) Patients are often encouraged to seek preventative screenings based on personal anecdotes rather than solid medical facts.
And the list goes on . . .

The author's conclusion is not to avoid screening and medical treatments resulting from a positive test. Instead he councils patients to weigh the negative outcomes against any potential benefits before choosing to be screened. He also encourages patients to give careful consideration before consenting to treatment for any asymptomatic "abnormality" discovered when testing for other complaints.

Chapter 1 discusses high blood pressure.
Chapter 2 discusses diabetes, high cholesterol, and osteoporosis.
Chapter 3 discusses medical imaging and the myriad of conditions such as bulging discs, blood clots, abdominal aortic aneurysms, damaged cartilage and gallstones that are often discovered when testing for other conditions.
Chapter 4 discusses prostate cancer, including the author's own reasons behind opting out of screening for it.
Chapter 5 discusses other cancers such as thyroid and colon cancer.
Chapter 6 discusses breast cancer.
Chapter 7 discusses "incidentalomas" that might or might not be cancerous.
Chapter 8 discusses other screenings such as cardiograms and ultrasounds.
Chapter 9 discusses genetic testing to determine if patients have elevated risks of developing certain diseases.
Chapter 10 is the author's conclusion.

The epidemic of overdiagnosis makes for an interesting albeit disturbing read. The statistics and charts occasionally make for dry reading, but overall the writing is accessible to all of us ordinary consumers of medical services.
24 von 25 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Everyone who sees a doctor should read this book 21. März 2011
Von J. Harvey - Veröffentlicht auf
Format:Gebundene Ausgabe|Verifizierter Kauf
I am a family physician. Recently I was told that I do not have enough time to explain risks and benefits of screening to my patients. I try to take the time, but many have been convinced by media and friends that 'good medicine' means 'early detection.' My risk and benefit speech is not what many want to hear. It's so much easier just to be told what to do. I hope Dr Welsh's insight spreads.
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Overdiagnosis occurs when individuals are diagnosed with conditions that will never cause symptoms or death. &quote;
Markiert von 21 Kindle-Nutzern
As we expand treatment to people with progressively milder abnormalities, their potential to benefit from treatment becomes progressively smaller. &quote;
Markiert von 19 Kindle-Nutzern
people with milder abnormalities stand to benefit less from treatment than those with severe abnormalities. &quote;
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