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Overdiagnosis is Damaging Health and Happiness America (Book: Over-Diagnosed)
A friend of mine has had two health scares in the past year. Both turned out, as I expected, to be a case of doctors calling out “issues” that were of no concern. But both times, it had negative impacts on his emotional state.
So I thought I’d repost this 2021 piece.
Follow the <not for your benefit>
When a doctor finds something, it might be a real issue, but often it’s of very low probability concern. But the doctor protects his/her ass from liability—it’s not for your benefit at all. So the slightest incidental finding is made into a Big Costly Deal. That’s the entire story. Follow the money and follow the self interest.
Doctors usually ignore or at best shrug-off the very real costs of overdiagnosis. But in fact, that behavior is itself a major contributor to misery. See the financial note below. And thus, IMO, doctors themselves are major contributors to harm in today’s assembly-line medicine corporate institution system. Sometimes unwitting and reluctant, but far too often active and eager participants. What a great business model!
Original post
Book: Overdiagnosed: Making People Sick in Pursuit of Health @AMAZON
For most of my life, I was a naive believer in “more preventive diagnosis is better”. It seemed to make sense. But the reverse is true, and for just about everyone. That’s because numerous harms follow from looking harder and harder for potential issues in otherwise healthy people.
@AMAZON
Sometimes (rarely) the harm is “only financial”*: I myself suffered from overdiagnosis when a brain scan some years ago delivered an incidental finding of a bulge in a major cranial artery, characterized as one that causes instant death for the 1% to 2% of people in which it ruptures.
* Financial harm can lead to homelessness, difficulty with utilities and food bills, etc. Accordingly and for many, financial harm is actually a grave physical and psychological threat, a destroyer of an already tenuous existence, and not just for the person diagnosed, but the entire family.
This shadowy thing on the scan (was it ever real?!) ended up costing me an extra $20,000 in tripled life insurance premiums over the next decade. Huge cost, negative benefit—nothing could be done about it. It worried me a little at first, but I decided to ignore it and so other harms were avoided (emotional, physical). Ten years later, that bulge had disappeared, as a follow-up scan proved. Which is the case for all sorts of incidental medical findings, including many cancers—apparent issues never become real issues, or just go away entirely.
Every one of us probably has half a dozen incidental latent issues that could raise concerns, leading to a lifetime of worrying, treatment with side effects, surgeries, etc. With few exceptions, the result is harm for many, and benefits for very few.
- The harder you look for things, the more you’ll find. Many of the “epidemics” are epidemics of overdiagnosis, with no change in the baseline deaths from the issue.
- Early diagnosis often has no impact whatsoever on the ultimate outcome, as double-blind studies prove. A life is not saved or improved; rather emotional, physical and financial harms all accrue.
- Life-changing harms can result from overdiagnosis: emotional, physical (drugs, surgery). Yet excepting a very few conditions, it is usually the case that more harm is done than good, as studies prove.
- With all sorts of medical issues, many go away on their own or regress, or just never develop into problems, or will never be an issue.
- Highly misleading medical marketing relies on anecdotes and misleading statistics to walk right up to the line on lying about the issues.
Even the routine annual physical exam is suspect here.
Overdiagnosed: Making People Sick in Pursuit of Health @AMAZON
Highly recommended.
@AMAZON
by Dr. H. Gilbert Welch, Dr. Steven Woloshin, Dr. Lisa M. Schwartz
