Friday, July 1, 2011


Have you been overdiagnosed? Chances are if you have been, you wouldn't know it. In the last two decades the profits of the medical industrial complex have been fueled by advanced technologies and incredible research; medical device firms expanded exponentially as doctors banded together to establish Open and Closed MRI centers. Big Pharm pays billions to advertise product in all the media outlets so that you can traipse to your doctor like Little Red Riding Hood in the forest of wolves and ask for that pill for Fibromyalgia or Restless Pain Syndrome. We've all laughed upon hearing the one symptom a medicine will cure and the raft of side effects it will cause, including death, or stroke and then death. But as we age, what are the chances that the overdiagnoses will cause more harm than good? In their book, Overdiagnosed; Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch, Dr. Lisa M. Schwartz and Dr. Steven Woloshin examine how the medical industrial complex has their own best interests at heart in the pursuit of diagnosing your diseases. And the risk reward ratio is phenomenal for them and may be disastrous for you.
If your sugar numbers are just slightly elevated, should you receive treatment or diet and exercise?

Welch is unrelenting, purposeful and specific citing facts, research and percentages that help to explain how we are in an "epidemic of diagnosis." He counters the conventional wisdom that all diagnosis is good for early prevention of disease by suggesting something novel. "Early diagnosis is a two-edged sword. While it has THE POTENTIAL to help SOME, it always has a hidden danger: overdiagnosis-the detection of abnormalities that are not destined to ever bother us."

 His argument is supported by research graphs, numbers, experience working with and in the medical industrial complex and testimonies.  How many women have gone in for a routine mammogram in their 30s for prevention, doing as their doctor suggested? Welch enumerates that for the thousands who have gone in and been exposed to radiation, the benefit is not as great as we are led to believe. He suggests that mammograms be given to women who are at increased risk, in their 50s. And even then, from my personal experience with two friends, the mammogram didn't pick up the cancer, both my friends discovered it with their own breast exam. So all of these young women receiving yearly mammograms? (I had my first in my 20s and it was my last.) Cui bono? (Who benefits?) Well that is a good question, is it not.

Welch discusses the intention of the medical industrial complex to look harder for disease, not to encourage prevention of disease with lifestyle habits that clearly work. The approach is standard mainstream and it is incredibly costly because the harder you look, the more you will find something (though you are without symptoms) but the findings do not necessarily yield healthier individuals because there are not enough randomized trials to discover if the individuals would have remained asymptomatic, if they were not treated. For example: osteoporosis. Welch on p. 26 has the following chart.

If 100 patients are diagnosed with near normal osteoporosis and treated for a lifetime, how many will be

WINNERS (treatment saved them from fracture)                                         5

TREATED FOR NAUGHT (had fracture despite treatment)                     44  

LOSERS (overdiagnosed-treatment couldn't help because they were never
going to have a fracture)                                                                              51

Welch had a discussion with a sales representative of one of the osteo drugs that had side effects (all of them do and they are noxious) and that never made it to the market. In a side conversation, the representative was honest after Welch's pointed questioning whether the drug prevented hip fractures. The rep said, "If we really wanted to prevent hip fractures, we'd take a different approach. Preventing falls in the elderly would go a longer way toward reducing hip fractures than ALL THE MEDICATIONS IN THE WORLD" (p. 153).

When the medical industrial complex finds a way to make money designing fall-free homes for the elderly, then hip fractures will be prevented. But until then? Give me some drugs!! (NOT!)

Welch discusses how numbers have been juggled and the thresholds lowered for diagnosing everything from hypertension to osteo to diabetes, to high cholesterol, etc. He questions the wisdom of this and asks if we are overdiagnosing and overmedicating because we can and it's encouraged? Cui bono? Not the patient. On the other hand, if someone is symptomatic, they must run to a doctor. He explains the difference between having symptoms and running for treatment and just getting treatment when there are no symptoms. The difference is a high tech instrument which shows everything, but doesn't show the malevolence or danger or risk (which may be low if even present). The danger or risk  would have to be ascertained by randomized trials which are longitudinal and not only go on for years, but also have to accrue a tremendous amount of evidence. Now come on, folks. TIME IS MONEY.

(Bear with me for a moment, folks. Here's the scenario. We've got a potential drug in the pipeline, which has possible side effects. Big Pharma brings out the bean counters and decides that by the time the side effects show up, the individuals, especially the elderly are dead and who can tell what they died from? They WERE ON THEIR WAY OUT ANYWAY. Meanwhile, another 10 years will have gone by and then someone cagey like a pack of wolfish litigators will notice that the drug does have side effects and people have been damaged. But by that point, so much money will have been made {through medicare, etc.} it is more cost effective to run the drug than not. By the time all the litigation has finished, elderly women who have a low threshold of payouts for insurance companies as opposed to young men in their prime with families to support (They get the most $$$ from personal injury claims.) won't cost Big Pharma much money by comparison. Meanwhile, the drug has been in existence churning up lots of bucks by the time the company has to recall it. The bean counters have once again proved their worth showing it is more cost effective to market a poison and run it gaining millions of dollars, than doing a longitudinal study which will take 15 years and will prove the drug is ineffective and has bad side effects and has to be tossed anyway. Cui bono?  Guinea pigs never live for very long, especially when served by the medical industrial complex.

So the FDA is convinced to keep the drug on the market and is Pontius Pilot by forcing Pharma to publish all the side effects which can be caused when taking the drug.(Since no one reads anyway, Big Pharma is off the hook.)  Big Pharma is thrilled at its new drug money maker which has caused ills, misery and possibly led to premature dying among the aged (an oxymoron if ever there was one) as well as a horrible quality of life in their last years. But who cares? The shareholders are happy: another rough irony since the elderly are the ones with the secure investment portfolios so they are seeing to their own demise in a way. And the last irony since women live longer than men, poisoning them this way is a kind of a just turnabout as they are dispatched more speedily to be with their already moldy graved husbands.

Now, you understand why few randomized trials are being done.           

If you have a healthy skepticism, Overdiagnosed is a necessary compliment in your library for you to make decisions with information the medical industrial complex (Welch's words) does not readily discuss, advertise or widely disseminate. And because of that very fact, I would read a book that uncovers more than others may want me to know, especially when it is in my best interest, not theirs.


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