HjemGrupperSnakMereZeitgeist
Søg På Websted
På dette site bruger vi cookies til at levere vores ydelser, forbedre performance, til analyseformål, og (hvis brugeren ikke er logget ind) til reklamer. Ved at bruge LibraryThing anerkender du at have læst og forstået vores vilkår og betingelser inklusive vores politik for håndtering af brugeroplysninger. Din brug af dette site og dets ydelser er underlagt disse vilkår og betingelser.

Resultater fra Google Bøger

Klik på en miniature for at gå til Google Books

Indlæser...

Overdiagnosed: Making People Sick in the Pursuit of Health

af H. Gilbert Welch

MedlemmerAnmeldelserPopularitetGennemsnitlig vurderingSamtaler
17511154,690 (4.3)Ingen
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.
Ingen
Indlæser...

Bliv medlem af LibraryThing for at finde ud af, om du vil kunne lide denne bog.

Der er ingen diskussionstråde på Snak om denne bog.

Viser 1-5 af 11 (næste | vis alle)
I've always liked technical papers that have a graphic in them that summarizes the whole paper. Dr. Welch and his coauthors' sobering look at over-diagnosis can be summarized with one graph that they present in the opening chapters:



We've been screening for more and more in asymptomatic patients in the last 50 years, based on the premise that it would be better to catch things early and treat them. So, have patient outcomes improved? After several million people have been affected by this onslaught, the answer is no. Welch explains why and why it's often a bad idea to screen well people.

I spent 35 years working in a hospital laboratory. Our relationship with the clinicians was usually cordial and sometimes actually cooperative, but now and then it was adversarial. Problems included how to deal with the request for an inappropriate test (tests that didn't really exist; tests that couldn't be controlled; tests that were incredibly expensive - but the clinician's attitude was that neither they nor the patient was paying for it, so...; tests whose results could not be interpreted; tests whose results could not help the patient no matter what the result was), how to explain that if every test were done "stat", then none of them would be, and how to explain that if more and more biopsies were done for an "abnormal" test (e.g. a radiograph) with creeping criteria for positivity, then one might expect that most of those patients would not have abnormal pathologic findings. Many of these problems came down to a lack of knowledge of the statistical properties of reality. Dr. Welch covers several of these problems directly and some of them by implication. His book is a breath of fresh air. ( )
  markm2315 | Jul 1, 2023 |
Should be required reading; it does have math in it, but be a big kid and read on- it's worth it. Sort like math and probability meet the medical profession. Doctors are trying to help their patients, but it just may be all the new technology and testing are not doing us as patients as much help as one might think. Basic lesson- no one is perfect and these superduper CT/MRI tests WILL find something awry just because we are not perfect systems. Money is an issue- I got the insurance report and my knee MRI cost $2000. Yikes. Someone MAY be making a profit here.If I were paying for it myself, I sure would not have taken one. There is so much here to talk about and learn, just read the book- even if you have to skim some parts. ( )
  PattyLee | Dec 14, 2021 |
This is probably one of the most important books I've ever read related to health. I would recommend it to most anyone. Best to read it when you're healthy (or mostly so), *before* getting any scans, tests, or diagnoses. There are times to seek medical care, doctors, and diagnosis - and there are times that they are best avoided. ( )
  tgraettinger | Nov 27, 2021 |
Interesting thoughts on screenings and stats you probably won't hear from your Dr unless you ask. I particularly liked the sections on money, diabetes, HBP, and pregnancy. Digging around the WHO and FDA website would benefit most of us during treatment. ( )
  OutOfTheBestBooks | Sep 24, 2021 |
Bashing the status quo is a common theme in popular health and medical non-fiction. Atul Gawande did it in Being Mortal, where he dispels the notion that extending lifespan is the sole goal of treating the elderly. Giles Yeo did it in his anti-diet Gene Eating. Overdiagnosed has a similar mission, this time targeting the need to find and correct every minor abnormality. It is, of course, a problem concentrated in the First World, where doctors, patients and corporations conspire with varying degrees of good will to achieve what statistics prescribe to be the healthy norm. To be more precise, Welch focuses on the US with its peculiar system of health insurance: "The United States is one of only two countries in the world that allow direct-to-consumer advertising of prescription drugs (the other is New Zealand)."

Welch takes a systematic look at some of the causes of overdiagnosis: (1) narrowing the acceptable range for metrics such as blood pressure, blood sugar and PSA (prostate specific antigen); (2) more powerful and frequent scans causing increased findings of benign abnormalities known as "incidentalomas"; (3) aggressive sampling of tissues to find indicators of cancer which may never cause a problem; (4) mail-order DNA analysis encouraging people to look for problems which may not exist.

I did enjoy Welch's journalistic exposé, partly because I am from the school of thought that healthy diet and activity should be the main focus for the average Joe rather than trying to preempt far-off conditions and diseases. As Welch puts it, "There is no need to do a genetic test to learn about the common, powerful risk factors for diabetes: obesity, sedentary lifestyle, and family history." The highlights for me are the statistical data which show how overdiagnosis "creates" problems; lucid explanations of cognitive biases which affect how statistics are presented and how we perceive them; and how positive feedback loops drive an endless cycle of testing and treatment.

Like Gawande, Welch believes treatment should be a collaboration between patient and doctor: "When we have major responsibilities to others, such as young children, we are likely to place more value on the 'staying alive' side of the equation. But later in life, we may place more value on 'staying well.' So we should expect that people will make different decisions about early diagnosis and that individuals’ decisions may change over time." Absolutely right.

Here I wish to record three of the biases which the layperson should keep in mind. First, absolute risk is more important than relative risk. Saying you are three times more likely to survive a condition if it is caught early via frequent testing is not useful if that condition's prevalence is one in a million and you are not otherwise predisposed. Second, survival rate statistics are plagued by lead-time bias. If two people die from a disease at 80, one was diagnosed at 74 via a regular test and the other at 76 when symptoms first present themselves, it's not helpful to consider the first person as having a longer survival rate. Third, overdiagnosis bias, while difficult to quantify because of the scale of studies required, is very real. If you "find" 50% more patients with a condition by narrowing your criteria, many of these relatively minor conditions will never materialise in ill health. If you are interested in this kind of behavioural science, refer to Daniel Kahneman's classic Thinking, Fast and Slow.

There are a few issues which I do not feel Welch adequately addressed. The obesity epidemic is absolutely real in the First World. Doctors and health practitioners need to play an active role in promoting good health in the overweight or malnourished. Metrics such as BMI are useful in this regard, but ranges need to be adjusted for ethnicity and considered alongside diet and exercise. Borderline high cholesterol, blood sugar and blood pressure in conjunction with being overweight need to treated differently to a single errant reading in a person who otherwise feels fine.

Another issue is how Welch in his zeal sometimes downgrades common practice as harmful with little evidence. Genetics has little value: "With the exception of a few relatively uncommon genetic mutations, by far the most important risk factor for breast cancer is a woman’s age." Yet that's the point: a doctor can and should use genetics if there is a family history and reasonable penetrance of cancer-associated genes. It's a tool to help people measure and manage risk rather than a factor which itself determines treatment. According to Welch, even ultrasounds for pregnant women are harmful, despite being cost effective and physically safe, because of the psychological impact of false positives.

Welch is on a mission and his arguments are one-sided. That said, sometimes you need a one-sided exposé to redress the balance of public opinion. ( )
  jigarpatel | Aug 2, 2020 |
Viser 1-5 af 11 (næste | vis alle)
He doesn’t offer prescriptions. He recognizes that different individuals will assess the risk/benefit ratio differently; based on the same data, some will choose to be screened and some won’t. But they deserve accurate information to base their decisions on, and this book offers a lot of good data and thought-provoking analysis.
 
Du bliver nødt til at logge ind for at redigere data i Almen Viden.
For mere hjælp se Almen Viden hjælpesiden.
Kanonisk titel
Originaltitel
Alternative titler
Oprindelig udgivelsesdato
Personer/Figurer
Vigtige steder
Vigtige begivenheder
Beslægtede film
Indskrift
Tilegnelse
Første ord
Citater
Sidste ord
Oplysning om flertydighed
Forlagets redaktører
Bagsidecitater
Originalsprog
Canonical DDC/MDS
Canonical LCC
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.

No library descriptions found.

Beskrivelse af bogen
Haiku-resume

Current Discussions

Ingen

Populære omslag

Quick Links

Vurdering

Gennemsnit: (4.3)
0.5
1
1.5
2
2.5
3 3
3.5
4 15
4.5 3
5 11

Er det dig?

Bliv LibraryThing-forfatter.

Beacon Press

Een udgave af denne bog er udgivet af Beacon Press.

» Information om udgiveren

 

Om | Kontakt | LibraryThing.com | Brugerbetingelser/Håndtering af brugeroplysninger | Hjælp/FAQs | Blog | Butik | APIs | TinyCat | Efterladte biblioteker | Tidlige Anmeldere | Almen Viden | 203,241,875 bøger! | Topbjælke: Altid synlig