Introduction and overview
According to conventional wisdom, the more the diagnosis, and especially early diagnosis, the better health and medical care treatment and management one is likely to receive, and in return the less the mortality rates. Apparently, this is not the case, according to one Dr. Gilbert Welch et al, in his book, ‘over- diagnosed making people sick in the pursuit of health’ who believes that more and more diagnosis leads to excessive treatment and that can actually have a negative impact on the patient’s health. This is because it makes people who are healthy feel less healthy and this can easily result to depression and add to the escalating costs of health. Accordingly, Dr Welch believes that over diagnosis is now becoming the biggest problem in modern medicine and is relevant to almost all the medical conditions. Having over 30 years of experience in medical practice, Dr Welch has presented significant evidence to support these claims. This paper shall explore his arguments and supportive evidence and also relate the same with the works of other renowned writers on the subject to evaluate the veracity of Dr Welch’s evidence.
Book review
In his book, Over-diagnosed: making people sick in the pursuit of health, Dr Welch explains that the American health care system is suffering significantly because of the aspect of over-diagnosis. In this regard, he explains that when one is over-diagnosed, it’s likely that this will exacerbate the problem as this person will now be more worried, than he was when he sought medical treatment. This, according to the author is a major cause of subsidiary medical conditions such as stress and depression and their related medical conditions.
The second argument fronted by the author is that treating cases of say severe hypertension is beneficial to those patients than offering treatment to those with mild cases of hypertension. The results reflect that treating those with lesser symptoms is likely to cause new problems and this may outweigh the value of the treatment of hypertension. What is meant by this assertion is that treating a patient with very mild ailments may actually cause more undesired results than waiting until the disease is noted and therefore managed efficiently.
Thirdly, Welch believes that it’s much more important to treat people that have disease symptoms, than those that may not have any. For instance, according to his study, almost 70pc of men aged between 60-69 years have cases of prostate cancer compared to about 10pc aged between the ages of 20-29. He offers that this 10pc is better off left untreated, because their particular issues may involve very slowly growing tumors and therefore the treatments may leave many undesired side effects which outweigh the benefits of offering the treatment. In a study that covered over 1000 people without symptoms at all, that underwent a total body CT screens, about 86% reported at least one abnormality detected, with an average detection standing at 2.8 abnormalities, with many of these abnormalities later disappearing without any treatment being offered. Providing unneeded treatment to these people therefore, is likely to subject them to unnecessary pain, expenses as well as unneeded adverse effects of this treatment.
In one example, Welch explains a case of an old man that he treated. Unfortunately, in the process of shoveling snow, the person passed out due to a combination of sweating and high blood pressure diuretics that had been prescribed and he had to discontinue the person’s medication. In another case, Dr Welch treated a patient that suffered from mild case of diabetes and the patient, while driving, fainted due to low blood sugar causing an accident that injured her badly and he had to discontinue her medication.
Dr Welch notes that while the number of target guidelines have since been tightened, the capacity and availability of the screening and detection equipment has significantly increased. In 1990’s for instance, Welch informs us that Medicare per capita utilization of head scans has doubled with the rated of abdominal scans tripling in the same period. Chest scans as well as brain MRI’s have quadrupled among other statistics. He notes, also, that new biopsy methods of detecting prostate cancer which includes sampling from 19 points rather than the usual 12 points or less is leading to detection of benign false- positive diagnoses even more than the actual prostate cancer positive cases, highlighting the problems posed by this issue of over diagnosis.
In an effort to explain why we have so many cases of over diagnosis, he explains that this may be greatly as a result of well meaning disease advocacy groups, as well as testimonials from famous people such as Senator Dole regarding his case of prostate cancer. Also, quality improvement efforts including testing as one of hospitals criteria or idea of quality improvement, malpractices in hospitals as well as hospital/ drug company or specialist marketing which Dr Welch warns people to be wary of (Brownlee, 2008).
Other authors and evidence is available, that supports the arguments presented by Dr Welch in his work. According to the Wall Street journal of January 18th 2011, there are apparently new Medicare requirements that one should be provided with a battery of up to 45 medical tests. In the same article, its reported that in the ‘‘New England Journal of Medicine’’, review of hundreds of preventive care research studies revealed that just a paltry less than 20 percent was able to save money at all.
According to Christopher Lane (2011), in his article Americans are being over diagnosed notes that there is an increased number of people, and especially young people aged between 12-17 who are already taking antidepressants compared to similar statistics a decade ago, and this is mainly because Americans are being too sensitive to minor health issues.
Another study by Moynihan Ray et al (2012) titled ‘preventing over diagnosis: how to stop harming the healthy explains that there is increasing evidence that medicine is harming the healthy, in its quest to cure, through the ever increasing earlier detection as well as the increasing wider definition of disease. The article shares examples of over diagnosis that is detecting cases of cancer that will probably never cause any death symptoms and others that will never grow beyond the size that it was detected. Another significant finding of this study is that while widening the definition of diseases is likely to reduce the human risk levels, it is an unnecessary thing since more than $200bn is wasted on unnecessary treatments and diagnoses each year, and also that cumulative burden arising from over diagnosis has always posed significant threat to the human health.
The above related literature supports Dr Welch’s claim that there is greater risk in over diagnosis than the benefits that accrue from the same. The bottom line, according to Welch therefore is to consider the aspects of improving healthcare while reducing costs, and recommends that more data from clinical trials should b utilized in determining the diagnostic standards and methods that should be used in administration of health care for an healthy society.
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References
Lane, C (2011) ‘‘Americans Are Being Aggressively Over-Diagnosed’’ Adapted from: http://www.psychologytoday.com/blog/side-effects/201110/americans-are-being-aggressively-over-diagnosed
Moynihan. et al (2012) Preventing over-diagnosis: how to stop harming the healthy. Adapted from: http://www.bmj.com/content/344/bmj.e3502
Welch, H.G. et al (2012) Over-Diagnosed Making People Sick in the Pursuit of Health. Beacon PressBrownlee, S (2008) Over-treated: Why Too Much Medicine Is Making Us Sicker and Poorer, Bloomsbury USA
