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Overdiagnosed: Making People Sick in the Pursuit of Health von [Welch, H. Gilbert, Lisa Schwartzl, Steve Woloshin]
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Overdiagnosed: Making People Sick in the Pursuit of Health 1 , Kindle Edition

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Produktbeschreibungen

Pressestimmen

“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 WorstPills.org

Kurzbeschreibung

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.

Produktinformation

  • Format: Kindle Edition
  • Dateigröße: 3813 KB
  • Seitenzahl der Print-Ausgabe: 248 Seiten
  • Verlag: Beacon Press; Auflage: 1 (18. Januar 2011)
  • Verkauf durch: Amazon Media EU S.à r.l.
  • Sprache: Englisch
  • ASIN: B004C43EW6
  • Text-to-Speech (Vorlesemodus): Aktiviert
  • X-Ray:
  • Word Wise: Aktiviert
  • Screenreader: Unterstützt
  • Verbesserter Schriftsatz: Aktiviert
  • Durchschnittliche Kundenbewertung: 4.5 von 5 Sternen 2 Kundenrezensionen
  • Amazon Bestseller-Rang: #419.417 Bezahlt in Kindle-Shop (Siehe Top 100 Bezahlt in Kindle-Shop)

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Von Lucipher am 3. August 2012
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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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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Amazon.com: 4.7 von 5 Sternen 233 Rezensionen
20 von 21 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen All patients and all doctors should be required to read this! 9. Juni 2015
Von D. Cusick - Veröffentlicht auf Amazon.com
Format: Taschenbuch Verifizierter Kauf
I've always felt a bit like an outlier in the current medical environment in the US, meaning that I've always done my best to avoid doctors at all costs. It's good to know they are there if I should break a leg, but prefer to leave them alone otherwise. In my 20s this was easy. It became less so in my 30s when I fell jumping over a fence and suffered a serious knee injury (shredded posterior cruciate ligament) that forced me into seeing doctors, and having surgery and lots of physical therapy. But the outcome was good and I still use that knee today, 30 years later. :-)

Then in my 40s I had an issue that forced me to see doctors again. It started innocently enough, mild nausea after eating. But it grew until I was nauseous after just about every meal, much intestinal distress also. I began throwing up on pretty much a daily basis, and finally began my series of doctors visits - and tests including abdominal X-rays, abdominal CAT scan, endoscopy, GI series .... and amazingly enough (especially after reading Dr. Welch's book) they found NOTHING wrong with me! I was throwing up my lunch every single day but I was in perfect health as far as all the tests went! The top-rated gastroenterologist I was sent to prescribed Prilosec and that seemed to help, so he basically said "No clue what is wrong since your tests are all normal, but since this helps I guess you will just be on Prilosec for life".

That was NOT the answer I wanted since my goal is to be on NO meds if possible, or as few as I can manage. I didn't want a "for life" pill when I was only in my 40s, for a condition of unknown cause. It was a *neighbor*, whose daughter had recently been diagnosed as celiac, who suggested to me that I try avoiding wheat for a week or two. That was actually hard to do since wheat is so ubiquitous that it's in virtually everything, but it was easier than facing a lifetime of drugs. I gave it a try and in *ONE WEEK* all my symptoms vanished! No more nausea, no more GERD, no more vomiting, no more intestinal distress. Even symptoms that I though were completely unrelated (my stiff achiness when I woke up in the morning) went away! And never to return as long as I avoid wheat - but no doctor ever suggested it.

I was later lucky to find a doctor whose attitude was fairly laissez-faire about medical treatment, didn't push the government line, was in favor of trying alternative methods like diet and exercise before turning to the prescription pad... but then I moved 1000 miles away so could hardly continue to see her.

So for four years in my new location I had no doctor, just the way I like it. But I'm not getting younger and had a few sicknesses this winter, was in a somewhat serious auto accident, so decided I should be on *someone's* books just in case I had a serious problem and needed help. I went for a GYN appt first, and got coerced into a mammogram and a bone density exam - something I had never done as saw no point to it. If they don't like the density of your bones the only thing they will do is prescribe a bisphosphonate which I would never take anyway (and Dr. Welch backs that up).

Sure enough, they found "osteopenia" in one hip and without even consulting me just TOLD me they had prescribed the bisphosphonate and I needed to start taking it immediately. They had already called in the prescription to my pharmacy.

Luckily I think I've struck gold with my new primary care doctor however. I saw her for the first time the next week and told her the story. She was totally in agreement with me and told me not to fill the prescription: "way too many bad side affects for almost no benefit" was how she put it. told me to try some weight-bearing exercises, eat calcium-rich foods, and make sure I got enough vitamin D. She is not another pill pusher by any means.

I don;t want to end up like my dad who was on about 20 different prescription meds by the end of his life, many with bad side affects, some drugs to combat the side affects of other drugs... He was prescribed a statin and blood pressure pills for NO GOOD REASON - 75 years old and a strong heart and a blood pressure of 110/65, but his cholesterol was "mildly" elevated (about 220) so the doctor said he needed both, and my sister and I are convinced that that was what ultimately led to his death. He lived for 6 more years but within months of going on the statins (which we were clueless about at that time) and BP meds he went from a strong vigorous 75-year-old to one who was hunched over, frail, constantly falling (as his BP would drop to something like 80/40 on the meds, causing him to faint), developed congestive heart failure (a known side affect of statins). My sister did some research and finally got his doctor to take him off the statins and BP meds - my dad was of the old school who did exactly what the doctor said and would never have dreamed of saying NO to any recommended med, or stopping one on his own. He did improve a bit after going off those drugs, but never really regained his health, and it was just a downward spiral from there over the next five years.

So I'm totally on-board with Dr. Welch's "less is more" philosophy. I found the book a quick and easy read. It was written clearly in terms perfectly understandable to the layman. One needn't have training in medicine or statistical analysis to understand the points Dr. Welch is trying to make. He explains it so clearly that I think my 5-year-old grandson could understand it. His writing style is engaging and holds your interest. He doesn't have too many case histories, but the ones he does have are all went worth reading about. I would recommend this book to anyone, but I think it truly needs to be REQUIRED reading as part of every medical school curriculum in this country,
10 von 10 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen According to the good doctor, overdiagnosis is a long recognized problem in ... 17. April 2015
Von Karen F. Duncan - Veröffentlicht auf Amazon.com
Format: Kindle Edition Verifizierter Kauf
Let me start by admitting my own confirmation bias. I have thought for a long time that we are over-medicalizing people and turning healthy people into patients. But I am a layperson and did not have the data to prove it. I am not a researcher. So, this was just intuition.

After reading H. Gilbert Welch's book, I have the data that confirmed my hunch. But I approached it with an open mind, as I do most of the media reports I've read about screening recommendations and the newest guidelines for who should take statins, when they should begin, etc. I try to be willing to listen to the real medical people and researchers. But I often get the nagging sensation that somewhere, years in the future, a meta analysis will come out disputing their current guidelines. It's certainly happened often enough in history.

So reading Dr. Welch, as he walks the reader through a careful analysis of the guidelines; a review of the evidence, including an explanation of what the statistics really say; and an explanation of the harms that overdiagnosis can cause, is refreshing and eye opening.

According to the good doctor, overdiagnosis is a long recognized problem in the medical field and it can lead to over-treatment of conditions that might never cause symptoms or harm the patient. But the treatment can, and often does, have side effects, some of which can have lifelong negative impact on the patient's health. Some of which can even lead to death.

Dr. Welch takes readers through a real analysis of cost versus benefit of screening and early and aggressive treatment of patients. He also presents a balanced view of the real risks that go both ways. He doesn't sugarcoat the risk that can come from deadly diseases like cancer. And he admits that there are times that catching a tumor when it is smaller and before it has spread leads to significantly better outcomes. The problem, though, is that many tumors are not deadly and will never grow or be threatening. But nobody can know which will tumors will be aggressive and deadly. So, once they are discovered, through screening, doctors often feel obligated to treat them all with equally aggressive treatments. An aggressive approach to a deadly cancer may be medically justified, but the same approach to one that may be dormant and never cause a problem is not justified, especially if it contains serious risks to life and health. The problem is with early screening you catch more of both types of anomalies and can't know the difference.

Dr. Welch argues that, in fact, while more cancers are diagnosed earlier, the rate of death has not gone down. You may have many seeming cures, but if the death rate has not been altered, it could just mean that more cancers that were never deadly have been overdiagnosed and treated, with accompanying unnecessary risks to the patient.

He does not advocate no screenings. In most cases, he suggests learning all the facts, weighing the risks, discussing it with one's doctor, and making informed decisions about when to be screened. He is neither anti-science nor opposed to traditional, Western medicine. He is a doctor whose own practice follows standard, modern protocols. And he uses his research knowledge to back up his claims with solid data. He also intersperses his arguments with personal anecdotes that demonstrate his arguments. But the anecdotes do not take the place of data, on which he spends most of the book.

Some of it gets repetitive and I found myself skimming toward the end when he seemed to be repeating his arguments over and over again. That is because he goes into great depth of analysis on a variety of different cancers that are screened for and the evidence always turned up the same facts, that too aggressive screening led to overdiagnosis, aggressive treatment, and potential harms, over and over again.

This is a great book to get a balance view from a doctor who practices traditional, conservative Western medicine and who has been a researcher with the U.S. Preventive Health Services, the group responsible for many of the revisions to the screening guidelines that made headlines in 2009. Read Dr. Welch's books, talks to your doctor, and make more informed choices regarding your health.
4 von 4 Kunden fanden die folgende Rezension hilfreich
4.0 von 5 Sternen More people are sicker and more people accept treatments that are at best insignificant and at worst harmful 14. Februar 2016
Von Amazon Customer - Veröffentlicht auf Amazon.com
Format: Taschenbuch Verifizierter Kauf
OVERDIAGNOSED brings to light a concern that too few Americans have. We trust out doctors and trust their tests so much that we don't even blink an eye at their diagnoses. The result? More people are sicker and more people accept treatments that are at best insignificant and at worst harmful. The author concentrates on America's common ailments (cancer, diabetes, and high blood pressure), although the principles can be applied to anything. The author considers the number of people who benefit from their doctors' diagnoses and those who spend countless dollars testing for an ailment they never likely had.

This book is insightful, although the writing is lackluster. It's very boring. The author uses charts to prove his point, making this more like a text book than pleasurable reading. This book is great for reference but not something you'd read for pleasure. I found the information helpful and kept this book for future reference.
44 von 46 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen The Fallacy of Early Detection 6. Juni 2012
Von Theresa Welsh - Veröffentlicht auf Amazon.com
Format: Taschenbuch Verifizierter Kauf
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.
196 von 198 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Good Insights - 22. Januar 2011
Von Loyd Eskildson - Veröffentlicht auf Amazon.com
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.
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