Overdiagnosis and Overtreatment

I’ve never been more concerned about the harms of healthcare. Any exposure to the health care system can get you in trouble.

It’s especially scary when healthy people enter the system–often in the name of prevention. Remember that the most likely outcome of a medical intervention in a person without complaints is harm. How can we make a person who says he is well any better?

The newest scourge is the treatment of risk factors–not diseases. It’s routine for me to see people admitted to the hospital because of side effects from drugs or procedures used to treat risk factors.

This morning, thanks to my friend Dr. Richard Lehman (University of Oxford), I found this trove of writing from Iona Heath. Dr Heath, a former president of the Royal College of General Practitioners, has written beautifully and extensively about the harms of overdiagnosis and overtreatment.

I loved her 15-minute Plenary Lecture here:

And her PowerPoint below addresses the ethical implications of excessive prevention, including the inconvenient truth of cancer screening. Pay attention to the image of how the creation of fear is like a stain in clear water–it can never be removed.

Ethical implications of excessive prevention

Her words inspire me to think differently, to think deeply. I hope they do the same for you.

JMM

4 comments

  1. Prevention does not equal Pharma.
    Definitely a frustration. Prevention should be food, exercise, lifestyle. But, based on the number of Walmart’s packed to the rafter’s with chemically created “calories’ , the lack of sidewalks, lack of recess in public schools, office cubicles, long school hours, school buses around the clock dropping children at their doors, massive hospitals and teaching hospitals dependent on grants to grow their power.. I could go on.
    The question is, where are Doctors in all of this? Writing more scripts for more meds and more tests.
    Today’s Drs and hospitals seem to be very involved in social and political issues- from supporting gun bans to deciding who is a good parent and who isn’t…
    They seem awfully silent on providing prevention advice that keep their script pad safely in the drawer.

  2. Nothing will happen. Confronting over treatment with ethical pontifications will do nothing to overcome the financial incentives to treat rather than prevent. If government watchdogs were not paid off, it’s possible over treatment could be controlled. But that is another idealist dream. In regard to modern medicine, caveat emptor. The problem is, for the overwhelmed, the ignorant and the poor, they can only naively accept the treatment that is doled out, having no idea of its consequences beforehand.

  3. Having just received a letter from my PCP that I need to return to be reevaluated for “hypertension”, I viewed the PowerPoint with great amusement. My “hypertension” scare apperently comes from a reading of 121/85. I guess that 85 will do me in unless i’m medicated immediately.

    In today’s world of prehypertension, prediabetes, slightly elevated cholesterol and slightly elevated PSA numbers, we all MUST have numerous tests and lots of drugs. I tell you, I’m not sure how we possibly made it this far without massive intervention.

    Gotta run, an ad on TV just told me I MUST see my doctor about some new drug I can’t pronounce. Not sure what it’s for, but I must need it. After all, it was just on television.

  4. Pardon me if this is s repost. I’m not sure it went out the first time:

    Bill, I popped over to your website and read your article regarding statins.

    While I agree with your points, especially those that show how statistics can be twisted, I hardly think the $11 for a three month supply of a generic statin is enriching big pharma. The new injectable treatment is a different matter altogether. Sounds like a solution in need of a problem.

    My concern is exactly where the line in the sand is drawn as to who actually benefits meaningfully from statins. The more I read, the more confused I become. At what calcium score point, if any, are statins justified? Are statins truly beneficial for individuals with afib?

    I have run the online calculators and found that even if your cholesterol levels were nearly 0, but you were over 60, you were “eligible” and recommended for statin therapy.

    I guess next, naysayers will be branded as “statin deniers”, similar to what’s happened to scientists who want to engage in reasoned debates regarding climate change.

    Regards

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