If you feel seriously sick, by all means go to a doctor. He or she could save your life. But if you feel fine, be wary of what some doctors might tell you in a regular checkup. Before you get yourself screened for cancer or agree to take medication, you owe it to yourself to read Overdiagnosed: Making People Sick in the Pursuit of Health by Drs. Gilbert Welch, Lisa Schwartz and Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice. These three unusually public-minded, clear-headed M.D.s describe, with careful statistical evidence, how an unholy alliance of the medical establishment and the pharmaceutical industry has conspired to redefine millions of healthy people as patients who need to be medicated for life.
Consider, for example, the treatment of high blood pressure. A systolic (when the heart beats) reading of 120 is considered good for a young person. But pressure rises with age, and it's not simple to know what to do about it. The old rule of thumb was that your pressure was normal if it was no more than your age plus 100, i.e. 160 for a 60-year-old. But in 1997, a blue-ribbon national panel of medical experts decided that anything over 140 at any age was too high. Recently, a friend of mine was put on pills for a blood pressure of 130. "Let's nip this in the bud," his doctor said. Similarly, the acceptable reading for total cholesterol has fallen over the years from 300 to 240 to 200. If you can't make the number, you're a candidate for anti-cholesterol drugs.
EDITOR'S NOTE: The rate of stroke and stroke fatality has declined dramatically as the treatment of hypertension has become more aggressive.
Because the standards have changed, millions have people have gone on medication for life. Shouldn't we applaud this as a wise and cautious policy? Maybe not. As the authors of Overdiagnosed point out, the milder the condition the less benefit you are likely to receive from treatment. If your blood pressure or cholesterol is only mildly elevated, the odds are high that something else is going to kill you.
Besides, these drugs aren't free. The drugs, and the office visits during which the doctors regularly renew the prescriptions, are a big part of our problem of soaring medical costs. You have to get suspicious when you consider who is setting the standards. As we learn in Overdiagnosed, "Nine of the eleven authors of recent blood pressure guidelines had some kind of financial ties -- as paid consultants, paid speakers, or grant recipients -- to drug companies that made high blood pressure drugs. Similarly, eight of the nine experts who lowered the cholesterol cutoff were paid consultants to drug companies making cholesterol drugs."
It's not just a matter of wasted money. Powerful drugs are not always harmless. Lead Overdiagnosed author Dr. Welch recalls, with much chagrin, how he once medicated an active elderly man for slightly elevated blood pressure, only to have the patient faint from an episode of low blood pressure. If we are putting millions of virtually normal people on drugs with potentially serious side effects for a lifetime, is it possible that the treatment will sometimes be worse than the disease?
That is often the case with cancer treatment. As scanning technology and lab testing grow ever more sophisticated, millions of cancers are discovered and treated even though they would never cause any serious symptoms. The most scandalous example is the treatment of prostate cancer. If a middle-aged man has a high score on a PSA test, it may just indicate an enlarged prostate gland, a generally benign, if annoying, condition. But the doctor will usually urge the patient to get a biopsy for prostate cancer. If the biopsy is positive, then the man has a dilemma. Does he have surgery to remove the prostate? The cancer might be an aggressive variety that will kill him, but much more likely it will be slow-growing, and something else will kill him.
Meanwhile, the surgery is often worse than the disease, since after the operation many of the patients become impotent and/or incontinent. Yet huge numbers of men are frightened enough of the cancer to have the surgery. Reporter Gina Kolata of The New York Times blew the whistle on this scandal several years ago. And the authors of Overdiagnosed estimate, based on the best studies, that for every one man who is saved from dying of prostate cancer, "somewhere between thirty and a hundred are harmed by overdiagnosis and treated needlessly." The book quotes no less an authority than University of Arizona College of Medicine Professor Richard Ablin, the man who discovered the "prostate-specific antigen," the enzyme that led to the development of the PSA test. Ablin contends that the use of his discovery to test for prostate cancer has led to a "profit-driven public health disaster."
My blog post is of necessity oversimplified, and there is much more in Overdiagnosed than I have room to mention, much less explore. There's a chapter on what the authors call "incidentalomas," strange unidentified spots that show up in X-rays and other scans and will probably never cause any problems, but are often treated anyway. There's a superb chapter on the ongoing mammogram controversy. And there's even a section on how ultrasound tests often unnecessarily scare pregnant women. Behind each surprising assertion are the statistics to back it up.
EDITORS NOTE: For more information on preventative health care services, and cancer screening recommendations, visit the U.S. Preventive Services Task Force website.
This is a chilling, disturbing book. Everyone should read it and understand it. The media would probably give the book more play if the media weren't so dependent on drug ads. After reading Overdiagnosed, I fear that the medical establishment is even more corrupt and dangerous than Wall Street. Bad financial advisers rob you of your money. Bad doctors can rob you of your money and your health.