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Overdiagnosed: Making People Sick in the Pursuit of Health


Overdiagnosed: Making People Sick in the Pursuit of Health Cover

ISBN13: 9780807022009
ISBN10: 0807022004
Condition: Standard
Dustjacket: Standard
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My first car was a ’65 Ford Fairlane wagon. It was a fairly simple—albeit

large—vehicle. I could even do some of the work on it myself. There was a lot

of room under the hood and few electronics. The only engine sensors were a

temperature gauge and an oil-pressure gauge.

Things are very different with my ’99 Volvo. There’s no extra room under

the hood—and there are lots of electronics. And then there are all those little

warning lights sensing so many different aspects of my car’s function that

they have to be connected to an internal computer to determine what’s wrong.

Cars have undoubtedly improved over my lifetime. They are safer, more

comfortable, and more reliable. The engineering is better. But I’m not sure

these improvements have much to do with all those little warning lights.

Check-engine lights—red flags that indicate something may be wrong

with the vehicle—are getting pretty sophisticated. These sensors can identify

abnormalities long before the vehicle’s performance is affected. They are

making early diagnoses.

Maybe your check-engine lights have been very useful. Maybe one of

them led you to do something important (like add oil) that prevented a much

bigger problem later on.

Or maybe you have had the opposite experience.

Check-engine lights can also create problems. Sometimes they are false

alarms (whenever I drive over a big bump, one goes off warning me that

something’s wrong with my coolant system). Often the lights are in response

to a real abnormality, but not one that is especially important (my favorite is

the sensor that lights up when it recognizes that another sensor is not sensing).

Recently, my mechanic confided to me that many of the lights should

probably be ignored.

Maybe you have decided to ignore these sensors yourself. Or maybe

you’ve taken your car in for service and the mechanic has simply reset them

and told you to wait and see if they come on again.

Or maybe you have had the unfortunate experience of paying for an

unnecessary repair, or a series of unnecessary repairs. And maybe you have

been one of the unfortunate few whose cars were worse off for the efforts.

If so, you already have some feel for the problem of overdiagnosis.

I don’t know what the net effect of all these lights has been. Maybe they

have done more good than harm. Maybe they have done more harm than

good. But I do know there’s little doubt about their effect on the automotive

repair business: they have led to a lot of extra visits to the shop.

And I know that if we doctors look at you hard enough, chances are we’ll

find out that one of your check-engine lights is on.

A routine checkup

I probably have a few check-engine lights on myself. I’m a male in my midfifties.

I have not seen a doctor for a routine checkup since I was a child. I’m

not bragging, and I’m not suggesting that this is a path others should follow.

But because I have been blessed with excellent health, it’s kind of hard to

argue that I have missed out on some indispensable service.

Of course, as a doctor, I see doctors every day. Many of them are my

friends (or at least they were before they learned about this book). And I can

imagine some of the diagnoses I could accumulate if I were a patient in any

of their clinics (or in my own, for that matter):

• From time to time my blood pressure runs a little high. This is particularly

true when I measure it at work (where blood pressure machines are

readily available).

Diagnosis: borderline hypertension

• I’m six foot four and weigh 205 pounds; my body mass index (BMI) is 25.

(A “normal” BMI ranges from 20 to 24.9.)

Diagnosis: overweight

• Occasionally, I’ll get an intense burning sensation in my midchest after

eating or drinking. (Apple juice and apple cider are particularly problematic

for me.)

Diagnosis: gastroesophageal reflux disease

• I often wake up once a night and need to go to the bathroom.

Diagnosis: benign prostatic hyperplasia

• I wake up in the morning with stiff joints and it takes me a while to loosen


Diagnosis: degenerative joint disease

• My hands get cold. Really cold. It’s a big problem when I’m skiing or

snowshoeing, but it also happens in the office (just ask my patients). Coffee

makes it worse; alcohol makes it better.

Diagnosis: Raynaud’s disease

• I have to make lists to remember things I need to do. I often forget

people’s names—particularly my students’. I have to write down all my

PINs and passwords (if anyone needs them, they are on my computer).

Diagnosis: early cognitive impairment

• In my house, mugs belong on one shelf, glasses on another. My wife

doesn’t understand this, so I have to repair the situation whenever she

unloads the dishwasher. (My daughter doesn’t empty the dishwasher, but

that’s a different topic.) I have separate containers for my work socks,

running socks, and winter socks, all of which must be paired before they

are put away. (There are considerably more examples like this that you

don’t want to know about.)

Diagnosis: obsessive-compulsive disorder

Okay. I admit I’ve taken a little literary license here. I don’t think anyone

would have given me the psychiatric diagnoses (at least, not anyone outside

of my immediate family). But the first few diagnoses are possible to make

based solely on a careful interview and some simple measurements (for example,

height, weight, and blood pressure).

What Our Readers Are Saying

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Average customer rating based on 1 comment:

dshivers, January 1, 2012 (view all comments by dshivers)
This is clearly the best book that I read in 2011. The author shows clearly how we have to move away from medical screening and rely on tests only for medical diagnosis of symptoms. He shows with multiple examples how very often screening without symptoms causes much more harm than good.
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Product Details

Making People Sick in the Pursuit of Health
Welch, H Gilbert
Woloshin, Steve
Schwartz, Lisa
Welch, H. Gilbert
Welch, H.
Beacon Press
General Medical
Health Care Delivery
Health and Medicine-Medical Specialties
Publication Date:
Grade Level:
9.26 x 6.26 x .86 in 1.1 lb

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Related Subjects

Health and Self-Help » Health and Medicine » General
Health and Self-Help » Health and Medicine » General Medicine
Health and Self-Help » Health and Medicine » Medical Specialties
Health and Self-Help » Health and Medicine » Politics of Health Care
Health and Self-Help » Health and Medicine » Professional Medical Reference
Reference » Science Reference » Technology

Overdiagnosed: Making People Sick in the Pursuit of Health Used Hardcover
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$16.95 In Stock
Product details 248 pages Beacon Press - English 9780807022009 Reviews:
"Synopsis" by , Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, a nationally recognized expert makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.
"Synopsis" by , From a nationally recognized expert, an exposé of the worst excesses of our zeal for medical testing


Diagnoses of every condition, from high cholesterol and high blood pressure to osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet Americans are living longer than ever. While the medical establishment credits aggressive early disease detection as the cause of improved public heath, it is in fact the reason so many of us are told we are sick. Going against the conventional wisdom that more screening is the best preventive medicine, Dr. H. Gilbert Welch builds a compelling counterargument that what we need is fewer, not more, scans and tests. 


Drawing on twenty-five years of medical practice and research on the effects of screening, Welch explains how the cutoffs for “abnormal” test results have been drastically lowered while at the same time technological advances have enabled doctors to detect more and more “abnormalities,” many of which will pose no health complications. Now, with genetic and prenatal screening common practice, patients are increasingly being diagnosed not only with disease but with “pre-disease.”


Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.

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