{"product_id":"overdiagnosed-isbn-9780807021996","title":"Overdiagnosed","description":"\u003cb\u003eA nationally recognized expert offers a searing exposé of Big Pharma and the American healthcare system’s zeal for excessive medical testing.\u003cbr\u003e\u003cbr\u003e\u003ci\u003eMore screening doesn’t lead to better health—but can turn healthy people into patients. \u003c\/i\u003e\u003cbr\u003e\u003c\/b\u003e\u003cbr\u003eGoing 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.\u003cbr\u003e\u003cbr\u003eDrawing on 25 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% of 2,000 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.\u003cbr\u003e\u003cbr\u003eWith 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.Table of Contents...\u003cbr\u003e\u003cbr\u003e \u003cb\u003eIntroduction: \u003c\/b\u003eOur Enthusiasm for Diagnosis\u003cbr\u003e\u003cbr\u003e\u003cb\u003eChapter 1)\u003c\/b\u003e Genesis: People Become Patients with High Blood Pressure\u003cbr\u003e\u003cb\u003eChapter 2)\u003c\/b\u003e We Change the Rules: How Numbers Get Changed to Give You Diabetes, High Cholesterol, and Osteoporosis\u003cbr\u003e\u003cb\u003eChapter 3)\u003c\/b\u003e We Are Able to See More: How Scans Give You Gallstones, Damaged Knee  Cartilage, Bulging Discs, Abdominal Aortic Aneurysms, and Blood Clots\u003cbr\u003e\u003cb\u003eChapter 4)\u003c\/b\u003e We Look Harder for Prostate Cancer: How Screening Made It Clear That Overdiagnosis Exists in Cancer\u003cbr\u003e\u003cb\u003eChapter 5)\u003c\/b\u003e We Look Harder for Other Cancers\u003cbr\u003e\u003cb\u003eChapter 6)\u003c\/b\u003e We Look Harder for Breast Cancer\u003cbr\u003e\u003cb\u003eChapter 7)\u003c\/b\u003e We Stumble onto Incidentalomas That Might Be Cancer\u003cbr\u003e\u003cb\u003eChapter 8)\u003c\/b\u003e We Look Harder for Everything Else: How Screening Gives You (and Your Baby) Another Set of Problems\u003cbr\u003e\u003cb\u003eChapter 9)\u003c\/b\u003e We Confuse DNA with Disease: How Genetic Testing Will Give You Almost Anything\u003cbr\u003e\u003cb\u003eChapter 10)\u003c\/b\u003e Get the Facts\u003cbr\u003e\u003cb\u003eChapter 11)\u003c\/b\u003e Get the System\u003cbr\u003e\u003cb\u003eChapter 12)\u003c\/b\u003e Get the Big Picture\u003cbr\u003e\u003cbr\u003e\u003cb\u003eConclusion:\u003c\/b\u003e Pursuing Health with Less Diagnosis\u003cbr\u003e\u003cbr\u003eAcknowledgments\u003cbr\u003eNotes\u003cbr\u003eIndex“Very insightful and engaging.”—Dennis Rosen, \u003ci\u003eThe Boston Globe\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“One of the most important books about health care  in the last several years.”—Cato Institute \u003cbr\u003e\u003cbr\u003e\"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, \u003ci\u003eThe New York Times\u003cbr\u003e\u003c\/i\u003e\u003cbr\u003e\"\u003ci\u003eOverdiagnosed\u003c\/i\u003e —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.\"─ \u003ci\u003eJAMA\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“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 \u003ci\u003eDr. Susan Love’s Breast Book\u003c\/i\u003e\u003cbr\u003e \u003cbr\u003e“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, \u003ci\u003eNew England Journal of Medicine\u003c\/i\u003e, and author of \u003ci\u003eA Second Opinion: Rescuing America’s Health Care \u003c\/i\u003e\u003cbr\u003e \u003cbr\u003e“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 \u003ci\u003eOverdiagnosed,\u003c\/i\u003e 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 \u003ci\u003eBritish Medical Journal,\u003c\/i\u003e and author of \u003ci\u003eSelling Sickness\u003c\/i\u003e\u003cbr\u003e \u003cbr\u003e“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 \u003ci\u003eWorried Sick\u003c\/i\u003e and\u003ci\u003e The Last Well Person\u003c\/i\u003e\u003cbr\u003e \u003cbr\u003e“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 \u003ci\u003eWorst Pills, Best Pills\u003c\/i\u003e and editor of WorstPills.org\u003cp\u003e\u003cb\u003eDr. H. Gilbert Welch\u003c\/b\u003e is a renowned authority on the effects of medical screening who has appeared on \u003ci\u003eThe Today Show,\u003c\/i\u003e CNN, NPR, and in the \u003ci\u003eNew York Times\u003c\/i\u003e and \u003ci\u003eWashington Post\u003c\/i\u003e. He and his coauthors, \u003cb\u003eDr. Lisa M. Schwartz\u003c\/b\u003e and \u003cb\u003eDr. Steven Woloshin,\u003c\/b\u003e nationally recognized experts in risk communication, are professors at the Dartmouth Institute for Health Policy and Clinical Practice. \u003cbr\u003e\u003c\/p\u003eMy first car was a ’65 Ford Fairlane wagon. It was a fairly simple—albeit\u003cbr\u003elarge—vehicle. I could even do some of the work on it myself. There was a lot\u003cbr\u003eof room under the hood and few electronics. The only engine sensors were a\u003cbr\u003etemperature gauge and an oil-pressure gauge.\u003cbr\u003e\u003cbr\u003eThings are very different with my ’99 Volvo. There’s no extra room under\u003cbr\u003ethe hood—and there are lots of electronics. And then there are all those little\u003cbr\u003ewarning lights sensing so many different aspects of my car’s function that\u003cbr\u003ethey have to be connected to an internal computer to determine what’s wrong.\u003cbr\u003eCars have undoubtedly improved over my lifetime. They are safer, more\u003cbr\u003ecomfortable, and more reliable. The engineering is better. But I’m not sure\u003cbr\u003ethese improvements have much to do with all those little warning lights.\u003cbr\u003eCheck-engine lights—red flags that indicate something may be wrong\u003cbr\u003ewith the vehicle—are getting pretty sophisticated. These sensors can identify\u003cbr\u003eabnormalities long before the vehicle’s performance is affected. They are\u003cbr\u003emaking early diagnoses.\u003cbr\u003e\u003cbr\u003eMaybe your check-engine lights have been very useful. Maybe one of\u003cbr\u003ethem led you to do something important (like add oil) that prevented a much\u003cbr\u003ebigger problem later on.\u003cbr\u003e\u003cbr\u003eOr maybe you have had the opposite experience.\u003cbr\u003e\u003cbr\u003eCheck-engine lights can also create problems. Sometimes they are false\u003cbr\u003ealarms (whenever I drive over a big bump, one goes off warning me that\u003cbr\u003esomething’s wrong with my coolant system). Often the lights are in response\u003cbr\u003eto a real abnormality, but not one that is especially important (my favorite is\u003cbr\u003ethe sensor that lights up when it recognizes that another sensor is not sensing).\u003cbr\u003eRecently, my mechanic confided to me that many of the lights should\u003cbr\u003eprobably be ignored.\u003cbr\u003e\u003cbr\u003eMaybe you have decided to ignore these sensors yourself. Or maybe\u003cbr\u003eyou’ve taken your car in for service and the mechanic has simply reset them\u003cbr\u003eand told you to wait and see if they come on again.\u003cbr\u003e\u003cbr\u003eOr maybe you have had the unfortunate experience of paying for an\u003cbr\u003eunnecessary repair, or a series of unnecessary repairs. And maybe you have\u003cbr\u003ebeen one of the unfortunate few whose cars were worse off for the efforts.\u003cbr\u003e\u003cbr\u003eIf so, you already have some feel for the problem of overdiagnosis.\u003cbr\u003e\u003cbr\u003eI don’t know what the net effect of all these lights has been. Maybe they\u003cbr\u003ehave done more good than harm. Maybe they have done more harm than\u003cbr\u003egood. But I do know there’s little doubt about their effect on the automotive\u003cbr\u003erepair business: they have led to a lot of extra visits to the shop.\u003cbr\u003e\u003cbr\u003eAnd I know that if we doctors look at you hard enough, chances are we’ll\u003cbr\u003efind out that one of your check-engine lights is on.\u003cbr\u003e\u003ci\u003e\u003cb\u003e\u003cbr\u003eA routine checkup\u003c\/b\u003e\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003eI probably have a few check-engine lights on myself. I’m a male in my midfifties.\u003cbr\u003eI have not seen a doctor for a routine checkup since I was a child. I’m\u003cbr\u003enot bragging, and I’m not suggesting that this is a path others should follow.\u003cbr\u003eBut because I have been blessed with excellent health, it’s kind of hard to\u003cbr\u003eargue that I have missed out on some indispensable service.\u003cbr\u003e\u003cbr\u003eOf course, as a doctor, I see doctors every day. Many of them are my\u003cbr\u003efriends (or at least they were before they learned about this book). And I can\u003cbr\u003eimagine some of the diagnoses I could accumulate if I were a patient in any\u003cbr\u003eof their clinics (or in my own, for that matter):\u003cbr\u003e\u003cbr\u003e• From time to time my blood pressure runs a little high. This is particularly\u003cbr\u003etrue when I measure it at work (where blood pressure machines are\u003cbr\u003ereadily available).\u003cbr\u003e\u003cb\u003eDiagnosis: borderline hypertension\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• I’m six foot four and weigh 205 pounds; my body mass index (BMI) is 25.\u003cbr\u003e(A “normal” BMI ranges from 20 to 24.9.)\u003cbr\u003e\u003cb\u003eDiagnosis: overweight\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• Occasionally, I’ll get an intense burning sensation in my midchest after\u003cbr\u003eeating or drinking. (Apple juice and apple cider are particularly problematic\u003cbr\u003efor me.)\u003cbr\u003e\u003cb\u003eDiagnosis: gastroesophageal reflux disease\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• I often wake up once a night and need to go to the bathroom.\u003cbr\u003e\u003cb\u003eDiagnosis: benign prostatic hyperplasia\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• I wake up in the morning with stiff joints and it takes me a while to loosen\u003cbr\u003eup.\u003cbr\u003e\u003cb\u003eDiagnosis: degenerative joint disease\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• My hands get cold. Really cold. It’s a big problem when I’m skiing or\u003cbr\u003esnowshoeing, but it also happens in the office (just ask my patients). Coffee\u003cbr\u003emakes it worse; alcohol makes it better.\u003cbr\u003e\u003cb\u003eDiagnosis: Raynaud’s disease\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• I have to make lists to remember things I need to do. I often forget\u003cbr\u003epeople’s names—particularly my students’. I have to write down all my\u003cbr\u003ePINs and passwords (if anyone needs them, they are on my computer).\u003cbr\u003e\u003cb\u003eDiagnosis: early cognitive impairment\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003e• In my house, mugs belong on one shelf, glasses on another. My wife\u003cbr\u003edoesn’t understand this, so I have to repair the situation whenever she\u003cbr\u003eunloads the dishwasher. (My daughter doesn’t empty the dishwasher, but\u003cbr\u003ethat’s a different topic.) I have separate containers for my work socks,\u003cbr\u003erunning socks, and winter socks, all of which must be paired before they\u003cbr\u003eare put away. (There are considerably more examples like this that you\u003cbr\u003edon’t want to know about.)\u003cbr\u003e\u003cb\u003eDiagnosis: obsessive-compulsive disorder\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003eOkay. I admit I’ve taken a little literary license here. I don’t think anyone\u003cbr\u003ewould have given me the psychiatric diagnoses (at least, not anyone outside\u003cbr\u003eof my immediate family). But the first few diagnoses are possible to make\u003cbr\u003ebased solely on a careful interview and some simple measurements (for example,\u003cbr\u003eheight, weight, and blood pressure).","brand":"Beacon Press","offers":[{"title":"Default Title","offer_id":46300193587429,"sku":"NP9780807021996","price":18.95,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9780807021996.jpg?v=1767734395","url":"https:\/\/k12savings.com\/products\/overdiagnosed-isbn-9780807021996","provider":"K12savings","version":"1.0","type":"link"}