Three medical practitioners concerned about the impact of increased use of diagnostic screening tools address the underlying causes and present their prescription.
Welch, Schwartz and Woloshin—professors at the Dartmouth Institute for Health Policy and Clinical Practice—assert that too many Americans are receiving unnecessary treatment for so-called abnormalities that are prevalent in the population but cause no symptoms, and thus no harm. Due to the increased use of high-tech diagnostic tools and a corresponding lowering of diagnostic thresholds, more of us are being told we meet the criteria for conditions and diseases that warrant intervention. The authors recognize that they are presenting a tough platform—isn’t it better, conventional wisdom states, to find and prevent high blood pressure or prostate cancer before actual onset of symptoms?—but their point is that it can be costly and even harmful. Potential problems become magnified, increasing numbers of people are labeled as patients and the side effects of many medications may generate more problems then they alleviate. Overdiagnosis leads to overtreatment, write the authors, who ask readers to look closely at claims that testing will save lives—e.g., “most women will not benefit from mammography—for example, about two thousand forty-year-old women need to be screened over ten years for one woman to benefit.” The authors do a fine job incorporating relevant medical terminology to bolster their argument. However, because citing randomized trials and rational risk estimates doesn’t hold great emotional weight, they also share their own common-sense observations as well as a body of research culled from many sources. The tone is sensible and serious but reassuring, and the authors make a strong case for moderation.
An antidote to alarmist thinking about the prevalence of disease.