Overdiagnosed

From a nationally recognized expert, an exposé of the worst excesses of our zeal for medical testing Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on twenty-five years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with "abnormal" test results have been drastically lowered just when technological advances have allowed us to see more and more "abnormalities," many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10 percent of two thousand healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with "pre-disease" or for being at "high risk" of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

From a nationally recognized expert, an exposé of the worst excesses of our zeal for medical testing Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on twenty-five years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with "abnormal" test results have been drastically lowered just when technological advances have allowed us to see more and more "abnormalities," many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10 percent of two thousand healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with "pre-disease" or for being at "high risk" of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

"This book, now revised in a section edition, examines the problem of over-diagnosis in psychiatry, focusing on problems with current diagnostic systems. It will show that diagnosis is not always a good guide to treatment selection, and that diagnoses have bee expanded in scope to justify currently popular methods of pharmacotherapy or psychotherapy. The most important categories that are over-diagnosed are bipolar disorders, major depression, attention-deficit hyperactivity disorder, and post-traumatic stress disorder. The boundary of pathology and normality remains unclear. This edition will also discuss dimensional systems that are transdiagnostic, and show how over-diagnosis is linked to the practice of aggressive psychopharmacology"--

A nationally recognized expert describes seven widespread assumptions that encourage excessive, ineffective, and sometimes harmful medical care—for readers of Overdiagnosed and Malcolm Gladwell You might think the biggest problem in medical care is that it costs too much. Or that health insurance is too expensive, too uneven, too complicated—and gives you too many forms to fill out. But the central problem is that too much medical care has too little value. Dr. H. Gilbert Welch is worried about too much medical care. He doesn’t deny that some people get too little medical care—rather that the conventional concern about “too little” needs to be balanced with a concern about “too much”: too many people being made to worry about diseases they don’t have and are at only average risk to get; too many people being tested and exposed to the harmful effects of the testing process; too many people being subjected to treatments they don’t need or can’t benefit from. The American public has been sold the idea that seeking medical care is one of the most important steps to maintain wellness. Surprisingly, medical care is not, in fact, well correlated with good health. More medicine does not equal more health; in reality the opposite may be true. In Less Medicine, More Health, Dr. Welch pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, he notes that while economics and lawyers contribute to the excesses of American medicine, the problem is essentially created when the general public clings to these powerful assumptions about the value of tests and treatments—a number of which are just plain wrong. By telling fascinating (and occasionally amusing) stories backed by reliable data, Dr. Welch challenges patients and the health-care establishment to rethink some very fundamental practices. His provocative prescriptions hold the potential to save money and, more important, improve health outcomes for us all.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

“Alan Cassels strips layers of expectation, hype, jargon, false-starts, and conflicts of interest off the medical screening mantra.” —Nortin M. Hadler, author of Worried Sick Why wouldn’t you want to be screened to see if you’re at risk for cancer, heart disease, or another potentially lethal condition? After all, better safe than sorry. Right? Not so fast, says Alan Cassels. His Seeking Sickness takes us inside the world of medical screening, where well-meaning practitioners and a profit-motivated industry offer to save our lives by exploiting our fears. He writes that promoters of screening overpromise on its benefits and downplay its harms, which can range from the merely annoying to the life threatening. If you’re facing a screening test for breast or prostate cancer, high cholesterol, or low testosterone, someone is about to turn you into a patient. You need to ask yourself one simple question: Am I ready for all the things that could go wrong? “With engaging clarity backed by academic rigor, Cassels discusses a variety of popular investigational procedures . . . an excellent way to start the important process of self-education.” —Quill & Quire “Smartly written and very readable.” —Brian Goldman, MD, author of The Secret Language of Doctors “Cassels tackles this touchy topic, looking at it test by test. His overarching message is that modern medicine has ‘overpromised’ with claims that screening will save our lives. He contends that with the lack of hard evidence on benefits, the evidence of harm from by such screening, as well as the multi-billion dollar interests at stake, we should approach this kind of screening with great precaution.” —Canadian Women’s Health Network

This book provides family doctors with a wealth of evidence-based indications and tips regarding geriatric medicine and approaches for the management of older patients, to be applied in daily practice. After discussing old and new features of healthy ageing and the approaches required in Family Medicine Consultation, the text introduces key elements of geriatric medicine such as frailty, sarcopenia, and the comprehensive geriatric assessment (CGA), before describing a range of characteristics unique to older patients in different contexts, with a dedicated section on Palliative Care. The role of polypharmacy and the importance of quaternary prevention and deprescribing are also addressed. Finally, the book emphasizes both the importance of a humanistic approach in caring and the approach of research and meta-research in geriatrics. Though many texts explore the role of primary care professionals in geriatric medicine, the role of family doctors in older people care has not yet been clearly addressed, despite the growing burden of ageing, which has been dubbed the “silver tsunami.” Family physicians care for individuals in the context of their family, community, and culture, respecting the autonomy of their patients. In negotiating management plans with their patients, family doctors integrate physical, psychological, social, cultural and existential factors, utilizing the knowledge and trust engendered by repeated visits. They do so by promoting health, preventing disease, providing cures, care, or palliation and promoting patient empowerment and self-management. This will likely become all the more important, since we are witnessing a global demographic shift and family doctors will be responsible for and involved in caring for a growing population of older patients. This book is intended for family medicine trainees and professionals, but can also be a useful tool for geriatricians, helping them to better understand some features of primary care and to more fruitfully interact with family doctors.

Debunks myths and misconceptions about ADHD, and discusses the controversies surrounding skyrocketing rates of diagnosis and medication treatment as well as the condition's cost to society.

A veteran clinical psychologist exposes why doctors, teachers, and parents incorrectly diagnose healthy American children with serious psychiatric conditions. In recent years there has been an alarming rise in the number of American children and youth assigned a mental health diagnosis. Current data from the Centers for Disease Control reveal a 41 percent increase in rates of ADHD diagnoses over the past decade and a forty-fold spike in bipolar disorder diagnoses. Similarly, diagnoses of autism spectrum disorder, once considered, has increased by 78 percent since 2002. Dr. Enrico Gnaulati, a clinical psychologist specializing in childhood and adolescent therapy and assessment, has witnessed firsthand the push to diagnose these disorders in youngsters. Drawing both on his own clinical experience and on cutting-edge research, with Back to Normal he has written the definitive account of why our kids are being dramatically overdiagnosed—and how parents and professionals can distinguish between true psychiatric disorders and normal childhood reactions to stressful life situations. Gnaulati begins with the complex web of factors that have led to our current crisis. These include questionable education and training practices that cloud mental health professionals’ ability to distinguish normal from abnormal behavior in children, monetary incentives favoring prescriptions, check-list diagnosing, and high-stakes testing in schools. We’ve also developed an increasingly casual attitude about labeling kids and putting them on psychiatric drugs. So how do we differentiate between a child with, say, Asperger’s syndrome and a child who is simply introverted, brainy, and single-minded? As Gnaulati notes, many of the symptoms associated with these disorders are similar to everyday childhood behaviors. In the second half of the book Gnaulati tells detailed stories of wrongly diagnosed kids, providing parents and others with information about the developmental, temperamental, and environmentally driven symptoms that to a casual or untrained eye can mimic a psychiatric disorder. These stories also reveal how nonmedical interventions, whether in the therapist’s office or through changes made at home, can help children. Back to Normal reminds us of the normalcy of children’s seemingly abnormal behavior. It will give parents of struggling children hope, perspective, and direction. And it will make everyone who deals with children question the changes in our society that have contributed to the astonishing increase in childhood psychiatric diagnoses.

A top expert on human trauma argues that we vastly overestimate how common PTSD is and fail to recognize how resilient people really are After 9/11, mental health professionals flocked to New York to handle what everyone assumed would be a flood of trauma cases. Oddly, the flood never came. In The End of Trauma, pioneering psychologist George A. Bonanno argues that we failed to predict the psychological response to 9/11 because most of what we understand about trauma is wrong. For starters, it’s not nearly as common as we think. In fact, people are overwhelmingly resilient to adversity. What we often interpret as PTSD are signs of a natural process of learning how to deal with a specific situation. We can cope far more effectively if we understand how this process works. Drawing on four decades of research, Bonanno explains what makes us resilient, why we sometimes aren’t, and how we can better handle traumatic stress. Hopeful and humane, The End of Trauma overturns everything we thought we knew about how people respond to hardship.

Breast Cancer Screening: Making Sense of Complex and Evolving Evidence covers broad aspects of breast cancer screening specifically focusing on current evidence, emerging evidence, and issues that will be critical for future breast screening practice such as tailored screening and shared decision-making in breast screening. The scope of the book is relevant to a global audience. This book provides balanced perspectives on this increasingly controversial topic, using scientific evidence to explain the evolution of knowledge relating to breast cancer screening. Breast Cancer Screening covers the key points related to this debate including the context of increasingly complex and conflicting evidence, divergent opinions on the benefits and harms of breast screening, and variability in screening practice and outcomes across settings around the world. Explains complex and evolving evidence on breast screening with a balanced approach Provides balanced information and up-to-date evidence in an increasingly complex area Addresses emerging topical issues such as screening trials of digital breast tomosynthesis, tailored breast screening, and shared decision-making in breast screening Assists academics and researchers in identifying areas needing further research

Focusing on high-yield information, Breast Imaging: The Core Requisites, 4th Edition emphasizes the basics to help you establish a foundational understanding of breast imaging during rotations, prepare for the core and certifying exams, refresh your knowledge of key concepts, and learn strategies to provide “value-added reports to referring clinicians. This completely rewritten and reorganized edition emphasizes the essential knowledge you need in an easy-to-read format, with thorough updates that cover new imaging modalities, the latest guidelines, and integration of physics information throughout. Emphasizes the essentials in a templated, quick-reference format that includes numerous outlines, tables, pearls, boxed material, and bulleted content for easy reading, reference, and recall. Prioritizes and explains the key information that you will be tested on to help you efficiently and effectively prepare for board exams. Helps you build and solidify core knowledge to prepare you for clinical practice with critical, up-to-date information on mammography, breast ultrasound, digital breast tomosynthesis, and breast MRIs, as well as special chapters on lymph node evaluation in breast imaging, augmented and reconstructed breast, and special populations in breast imaging. Features hundreds of high-quality images, including correlations of ultrasound, mammography, digital breast tomosynthesis and MRI. Published as part of the newly reimagined Core Requisites series, an update to the popular Requisites series aimed at radiology trainees and today’s busy clinicians.

In this thought-provoking volume, a physician and public health expert challenges the notion that detecting cancer early always saves lives.

How We Do Harm exposes the underbelly of healthcare today—the overtreatment of the rich, the under treatment of the poor, the financial conflicts of interest that determine the care that physicians' provide, insurance companies that don't demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm. Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (but as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary—and often unproven—treatments that we all pay for. Brawley calls for rational healthcare, healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs. Brawley's personal history – from a childhood in the gang-ridden streets of black Detroit, to the green hallways of Grady Memorial Hospital, the largest public hospital in the U.S., to the boardrooms of The American Cancer Society—results in a passionate view of medicine and the politics of illness in America - and a deep understanding of healthcare today. How We Do Harm is his well-reasoned manifesto for change.

In Borderline Personality and Mood Disorders: Comorbidity and Controversy, a panel of distinguished experts reviews the last two decades of progress in scientific inquiry about the relationship between mood and personality disorders and the influence of this empirical data on our ways of conceptualizing and treating them. This comprehensive title opens with an introduction defining general trends both influencing the expansion of the mood disorder spectrum and undermining clinical recognition and focus on personality disorders. The overlaps and differences between MDD and BPD in phenomenology and biological markers are then reviewed, followed by a review of the overlaps and distinctions between more atypical mood disorder variants. Further chapters review the current state of thinking on the distinctions between bipolar disorder and BPD, with attention to problems of misdiagnosis and use of clinical vignettes to illustrate important distinguishing features. Two models explaining the relationship between mood, temperament, and personality are offered, followed by a review of the literature on risk factors and early signs of BPD and mood disorders in childhood through young adulthood as well as a review of the longitudinal studies on BPD and mood disorders. The last segment of the book includes three chapters on treatment. The book closes with a conclusion with a synthesis of the current status of thinking on the relationship between mood and borderline personality disorder. An invaluable contribution to the literature, Borderline Personality and Mood Disorders: Comorbidity and Controversy insightfully addresses the mood and personality disorders realms of psychiatry and outlines that it has moved away from contentious debate and toward the possibility of synthesis, providing increasing clarity on the relationship between mood and personality to inform improvements in clinical management of the convergence of these psychiatric domains in common practice.

Every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done? In The Great Prostate Hoax, Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventurally approved by the FDA in 1994. Now, doctors and victims are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker.

Mind Fixers tells the history of psychiatry’s quest to understand the biological basis of mental illness and asks where we need to go from here. In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds. But when the Freudians overreached, they drove psychiatry into a state of crisis that a new “biological revolution” was meant to alleviate. Harrington shows how little that biological revolution had to do with breakthroughs in science, and why the field has fallen into a state of crisis in our own time. Mind Fixers makes clear that psychiatry’s waxing and waning biological enthusiasms have been shaped not just by developments in the clinic and lab, but also by a surprising range of social factors, including immigration, warfare, grassroots activism, and assumptions about race and gender. Government programs designed to empty the state mental hospitals, acrid rivalries between different factions in the field, industry profit mongering, consumerism, and an uncritical media have all contributed to the story as well. In focusing particularly on the search for the biological roots of schizophrenia, depression, and bipolar disorder, Harrington underscores the high human stakes for the millions of people who have sought medical answers for their mental suffering. This is not just a story about doctors and scientists, but about countless ordinary people and their loved ones. A clear-eyed, evenhanded, and yet passionate tour de force, Mind Fixers recounts the past and present struggle to make mental illness a biological problem in order to lay the groundwork for creating a better future, both for those who suffer and for those whose job it is to care for them.

More than 1 in 7 American children get diagnosed with ADHD - three times what experts have said is appropriate - meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives. -- Provided by publisher.

In this groundbreaking and controversial book, behavioral neurologist Dr. Richard Saul draws on five decades of experience treating thousands of patients labeled with Attention Deficit and Hyperactivity Disorder—one of the fastest growing and widely diagnosed conditions today—to argue that ADHD is actually a cluster of symptoms stemming from over 20 other conditions and disorders. According to recent data from the Centers for Disease Control and Prevention, an estimated 6.4 million children between the ages of four and seventeen have been diagnosed with attention deficit hyperactivity disorder. While many skeptics believe that ADHD is a fabrication of drug companies and the medical establishment, the symptoms of attention-deficit and hyperactivity are all too real for millions of individuals who often cannot function without treatment. If ADHD does not exist, then what is causing these debilitating symptoms? Over the course of half a century, physician Richard Saul has worked with thousands of patients demonstrating symptoms of ADHD. Based on his experience, he offers a shocking conclusion: ADHD is not a condition on its own, but rather a symptom complex caused by over twenty separate conditions—from poor eyesight and giftedness to bipolar disorder and depression—each requiring its own specific treatment. Drawing on in-depth scientific research and real-life stories from his numerous patients, ADHD Does not Exist synthesizes Dr. Saul's findings, and offers and clear advice for everyone seeking answers.