Overdiagnosed: Making People Sick in the Pursuit of Health

H. Gilbert Welch, MD, MPH
Professor of Medicine, Dartmouth Institute for Health Policy & Clinical Practice

2314th Meeting Abstract
Friday, March 8 2013 8:15 PM

Sponsored by Tim Thomas

Abstract:

Over the past several decades, there has been a growing enthusiasm for early diagnosis - engaging many physicians in a systematic search for abnormalities in people who are well. Partly as a result, diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet many of the individuals given these diagnoses never develop the symptoms from their conditions. They are overdiagnosed. And, while overdiagnosed patients cannot benefit from treatments for these conditions - there is nothing to treat - the treatments themselves can be harmful to them. Because of this it is critical to understand the trade-offs between diagnosis and over-treatment, and to be sure that health care systems don't narrow the definition of normal so that - ironically - people are needlessly turned into patients and subjected to treatments that do harm instead of good.

The lecture will discuss the definition of overdiagnosis - the detection of an "abnormality" that would have otherwise never become evident during an individual's lifetime. It will describe the proximate mechanisms for overdiagnosis in current medical practice, such as changing rules, seeing more, looking harder, and tumbling onto things. It will explore the evidence for overdiagnosis and its harms. And it will consider approaches to mitigate the problem.

About the Author:

H. Gilbert Welch

H. Gilbert Welch is Professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research in the Geisel School of Medicine, Professor of Public Policy at Dartmouth College, Professor of Business Administration at Dartmouth's Amos Tuck School and a practicing general internist at the White River Junction Veterans Administration Medical Facility.

He has been practicing medicine and doing medical research for 25 years, and for a time served as Visiting Scientist at the International Agency for Research on Cancer. His research has been on early detection of diseases, particularly melanoma, thyroid, lung, breast and prostate cancer. The research has led him to counter-intuitive conclusions: that physicians test too often, treat too aggressively and tell too many people that they are sick without significant health benefits, often with detrimental effects.

His scholarly work has been published widely in leading medical journals, including the Annals of Internal Medicine, the Journal of the American Medical Association, the New England Journal of Medicine and the Journal of the National Cancer Institute. He is published frequently in the national media, including the New York Times and Los Angeles Times. His first book, Should I be tested for cancer? Maybe not and here's why was listed by Malcolm Gladwell as one of the six "best books" of the year in The Week. His second book, Overdiagnosed: Making people sick in the pursuit of health, was published in 2011.


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