May 2012 Brief: Volume 19, Number 15
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Health Care and the Problem of Overdiagnosis
by John Hendrickson
As the future of the Patient Protection and Affordable Care Act (Obamacare) awaits its judgment by the United States Supreme Court, policymakers and individuals need to begin looking at different policies and ideas to not only reduce the cost of health care, but also improve the quality of service. In Over-Diagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch and co-authors Dr. Lisa M. Schwartz and Dr. Steven Woloshin discuss the nature of overdiagnosis, which “is the biggest problem posed by modern medicine. It is a problem relevant to virtually all medical conditions.” The authors argue that “this book is about the relentless expansion of medicine and our increasing tendency to make diagnoses.”
Though many policy problems confront health care in the United States, our nation still has the best health-care service in the world. The American health-care system provides not only quality care, but also an economic system that encourages growth in technology along with research and development in order to increase the quality of treatment. Health care is a large part of our culture. Our society is inundated with health/medical ads on media outlets across-the-board that encourage healthy living, early screening, and new medications, among many others. As the authors of Over-Diagnosed explain:
This is where the problem of overdiagnosis becomes an issue in our health-care system. “Overdiagnosis is a relatively new problem in medicine,” as the authors note:
Some of the examples that the authors write about in the book include hypertension (high blood pressure) and diabetes. In regard to hypertension, “before the late 1990s, a blood pressure reading of 160-over-100 was considered the threshold for the diagnosis...; today it is 140-over-90.” A similar situation applies to blood sugar numbers when diagnosing diabetes. Welch notes that when he was “in medical school,” a “fasting blood sugar over 140” was a diagnosis for diabetes, but today that number has been lowered to 126 as a result of a special committee.
This change in diagnosing both hypertension and diabetes can be both good and problematic:
The authors argue that “the problem of overdiagnosis stems directly from the expansion of the pool of individuals in whom we make diagnoses: from individuals with disease (those with symptoms) to individuals with abnormalities (those without symptoms).” In addition, they argue that “all treatments have the potential to do some harm,” but a patient who is “overdiagnosed cannot benefit from treatment. There’s nothing to be fixed…”
Throughout the book the authors are careful not to dismiss the seriousness of diagnosis, “especially for those who are sick.” Nor is it an endorsement for “alternative medicine,” but rather “for the many who are (or used to be) basically well — or those who have one illness and are at risk of being told they have others.” “The question I’m raising is not whether you should seek out a doctor — and a diagnosis — when you are sick…The question is about when you are well. How hard should a doctor look for things to be wrong?” asked Welch
Over-Diagnosed provides a serious overview of a problem that confronts health care from all directions. The thesis of the book provides a synopsis of why overdiagnosis is a crucial issue:
 Dr. H. Gilbert Welch, Dr. Lisa M. Schwartz, and Dr. Steven Woloshin, Over-Diagnosed: Making People Sick in the Pursuit of Health, Beacon Press, Boston, Massachusetts, 2011, p. 180.
John Hendrickson is a Research Analyst with Public Interest Institute, Mount Pleasant, Iowa. Contact him at Public.Interest.Institute@LimitedGovernment.org.
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