• by H. Gilbert Welch, Lisa M. Schwartz, Steven Woloshin
  • Narrated by Sean Runnette
  • 9 hrs and 40 mins
  • Unabridged Audiobook

Publisher's Summary

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 25 years of medical practice and research, Dr. H. Gilbert Welch and his colleagues, Dr. Lisa M. Schwartz and Dr. Steven Woloshin, have studied the effects of screenings and presumed preventative measures for disease and pre-disease. Examining the social, medical, and economic ramifications of a health care system that unnecessarily diagnoses and treats patients, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, debilitating anxiety, and exorbitant costs.


What the Critics Say

"This accessible and important book will help the reader understand the limitations of modern medicine and the perils inherent in an overzealous pursuit of a disease-free existence at any cost. It is also especially timely in raising one of the many issues surrounding the health-care debate." (Dennis Rosen, The Boston Globe)
"One of the big strengths of this relatively small book is that if you are inclined to ponder medicine's larger questions, you get to tour them all. What is health, really? In the finite endeavor that is life, when is it permissible to stop preventing things? And if the big questions just make you itchy, you can concentrate on the numbers instead: The authors explain most of the important statistical concepts behind evidence-based medicine in about as friendly a way as you are likely to find. (Abigail Zuger, M.D., The New York Times)


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Customer Reviews

Most Helpful

Agreed, Too Many Medical Interventions

A medical, scientific version of the old saw "if it ain't broke, don't fix it", and I applaud the exploration of current trends in testing and imaging of people previously considered "normal" and healthy and turning them into patients. The guidelines for abnormality are constantly shifting, mostly to the financial advantage of those involved in the health profession.

This is not a polemic against the use of doctors; just a warning to be a sceptic and be cautious in hopping on board the testing bandwagon and being turned into a patient, just another profit center for physicians, health facilities, imaging centers and health insurance companies. Of course, testing, scanning and other modalities can helpfully put an at-risk patient, someone in danger of incurring future serious negative health outcomes, into the domain of "healthy", but it's important to apply the brakes to the current trend in speed-testing an otherwise asymptomatic and a healthy individual.

The author also cautions against making use of the current genetic profiling technology in order to apprise oneself of any hereditary genes gone wrong. In this situation, perhaps, and only perhaps, some good can be achieved by knowing of a high percentage of likelihood for a smattering of seriously debilitating diseases which would have life-altering consequences both in terms of treatment and in terms of the disease itself.

I'd only agree with this position if no treatment was available to fix the genetic glitch, or remedy for the statistical probability of negative outcome. So, now that you know, but what can you do about it? In the case of breast and ovarian cancers, however, the answer to this question is...plenty!!!

With the ever-increasing knowledge of specific deleterious genetic information, and the identification of the genes BRAC 1 & 2, it is now possible to divert and indeed eliminate the occurrence of breast and ovarian cancer. Recurrence is always a consideration, but that could happen with or without surgical intervention. With an 87% of getting breast cancer and a 50% chance of getting ovarian cancer, an otherwise healthy individual with these genetic glitches cannot afford to "watch and wait"...to get cancer, in many cases.

The preventative surgeries for these diseases are not without risk and consequence in quality of life, especially for women of child-bearing age but additional interventions such as breast reconstruction (provided by health insurance) and assisted fertility in the case of prophylactic oophorectomy, can help mitigate the effects - such as sudden early menopause, loss of fertility, negative body image - that are concomitant with these procedures. In other words, you can have re-engineered breasts and can continue to bear children with banked embryos.

This is just to say there are situations where screening is helpful and though monitoring is inconvenient, it beats getting cancer.

On most points the book's general thesis is spot-on, and counters the myth that over-diagnosis, especially considering litigation, is always better. But is it really? In terms of accomplishing nothing in many case but initiating further testing and surgeries and resultant anxiety is it always helpful??

Above all do no harm. Just depends on how "harm" is defined.

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- Pamela Harvey "glam"

I am a victim

I have argued with my doctor for years. He thinks I should take cholesterol medications. I told him I don't want the side effects. He gave me a glucose monitor, I don't use it. His medical assistant thought I should be on Metformin for my "pre-diabetes." I said no. I'm not just stubborn. I saw the damage to my mother's quality of life caused by prescription drugs. I have several friends whose lives revolve around getting the right balance to the many drugs they take. I have worked seven years in a medical oncology clinic. (We give chemo.)

This book brought out points that I had not considered, but make perfect sense. I think everyone should read it, but it won't change anything. Too many people are eager to sue.
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- Teresa Gregory "Aserethtor"

Book Details

  • Release Date: 09-11-2012
  • Publisher: HighBridge, a division of Recorded Books