Wednesday, October 26, 2011

"Making people sick in the pursuit of health"

I'm traveling to Boston tomorrow to participate in a panel discussion on Friday for this year's William J. Bicknell Lectureship at the Boston University School of Public Health. The keynote speaker is H. Gilbert Welch, MD, MPH, author of the books Should I Be Tested For Cancer? Maybe Not and Here's Why and Overdiagnosed: Making People Sick in the Pursuit of Health, which I reviewed in a previous blog post. Here's an excerpt to give you a flavor of that review:

As H. Gilbert Welch and colleagues argue convincingly in their new book, ... much of the rise in cancer diagnoses over the past several decades has been the result of overdiagnosis: the detection (through screening or incidental finding on medical images obtained for other reasons) of cancers that would otherwise never have caused problems for patients. In the absence of screening, patients would not have developed symptoms because the "cancer" would not have progressed, or the patient was destined to die from some other cause (typically, heart disease). In the presence of screening, however, they suffer the psychological effects of knowing that they have cancer, the complications of diagnostic procedures, and the consequences of unnecessary treatments.

Seen in this light, the rise in cancer survivorship is not a modern medical success story. For millions of patients who received diagnoses that they didn't need and would do nothing to improve their health, it is a catastrophe.

BU Today just published a nice interview with Dr. Welch that connects the theme of overdiagnosis with the U.S. Preventive Services Task Force's recent draft recommendation against PSA screening for prostate cancer and his sobering new paper in the Archives of Internal Medicine that estimates the likelihood that a patient with screen-detected breast cancer has had her "life saved" to be less than 15 percent.

I am very much looking forward to meeting Dr. Welch and fellow panelists Deborah Bowen and John Fallon and having a terrific discussion!


  1. Mammograms every year age 40 to 50 result in more interventions that result in more consequences with little saving of life. Even when suspicious areas are detected, the obligation is to biopsy and even 7% of biopsies are false positives - resulting in major surgery on patients that did not even have breast cancer. Digital mammogram implementation across the nation cost millions more without an improvement. Raise a Stink about Pink covers these and other areas when marketing takes over. The innovative pap smear techniques were also no more helpful. Doing too many pap smears continues on the wrong patients with too few on those needing paps. BSE and testicular self exam are no help, PSA was bad, and eye screens on kids less than 3 result in too much done. Simple things such as painting teeth that work for kids and for cost savings are not done - perhaps little to gain from simple that works.

  2. I'm glad to read this because you've put in words what I've thought so many times... Excuse me for my poor English, but I've been reading your blog for a while and I find it so interesting.

    My ob/gyn told me I was oblivious and childish because I didn't want to get a Papanicolau while being pregnant: "if you have a cancer, you should know now", she told me... Being not-so-old (31) and healthy, I didn't want to make any exam but those necessary. And no, I didn't want to think about cancer while pregnant, thank you!

    By the way, my second son was delivered by a professional midwife at home, and, like your second daughter, he was a wonderful VBAC. Here we usually say "¡Sí, podemos!"

    Good work!! Greetings from Spain!

  3. Is the speach on You Tube or available anywhere that you know about? I'd love to see it.

  4. No, I'm afraid that the session wasn't taped, but here's a link to a nice interview with Gil Welch on YouTube: