Reddit reviews Overdiagnosed: Making People Sick in the Pursuit of Health

I'm surprised more people on here aren't bringing up the term 'overdiagnosis'.

Overdiagnosis is a problem facing the medical industry today because our ability to detect and diagnose has surpassed our ability to predict and treat.

That means that men go through unnecessary prostate cancer treatments (surgery to remove the prostate leaves many men impotent and incontinent). The treatments are unnecessary because most forms of prostate cancer grow so slowly a man lives out his natural life before symptoms of the cancer appear.

If you're interested a good book is 'Overdiagnosed'. Prostate cancer isn't the only area humanity is having trouble with, either.

There's a SmartEM podcast on the topic. I found it fairly convincing.

However, one doesn't need to do a deep literature search on this. It's a fundamental trend in medicine: the smaller the risk of a bad outcome, the less potential good an intervention can do. This means that for most "population health"-level interventions (e.g., statins in populations without heart disease), the adverse effects of the intervention are generally going to vastly outweigh the benefits.

That's not an absolute rule (e.g., vaccination), but it's a safe default position until firmly proven otherwise. Generally, we don't do these sorts of interventions because there's good evidence for them. We tend to jump the gun on the principle that "if X saves lives in Condition, imagine how much good it would do if we just got there earlier!" Except, earlier, the cost-benefit discussion is entirely different.

A good read on the topic is Overdiagnosed, which for some reason got a "popular medicine" cover for a book that's really aimed at clinicians.

The issue of overdiagnosis is huge in medicine right now. In one of my med school classes we read this book

It was very enlightening and written for the general public and not just medical professionals by one of the leaders on the subject. Check it out if you have some free time on your hands. It's a fast read.

>Lasik is a horrible example

Fair. I hesitated to use it but decided to use the first medical example that came to mind. I will say though that from everything I've read lately, I don't think the procedure is as dangerous as made out to be. Serious, lasting side effects percentage-wise are still low and improving despite the issues. I also think there needs to be due diligence on the part of the patient. I probably wouldn't get Lasik myself, but if I ever do, I'm going to do my research to find a reputable program for it and understand the risks. I'll also note, there are many 'regulated' procedures done in fancy hospitals that I would never agree to because they also pose a level of risk that I'm not comfortable with. There's risk in any health procedure.

>but your argument breaks down when early detection and payment of say heart medications would increase quality of life and make patients live longer and overall be cheaper to everyone, insurers and providers.

1. I recommend the book "Overdiagnosed" by Dr. Gilbert Welch. Not part of this conversation, but thought provoking on the issue of early detection.
   
2. We can have 'free market' healthcare with out of pocket expenses for medication and still cheap costs. Here I suggest reading into a relatively new field in healthcare called "direct primary care". It's essentially a primary care service that covers normal doctor visits, all kinds of minor procedures, and basic medications for a single monthly subscription. They can do stitches, BP or heart medication, etc all under that subscription since they can buy the stuff wholesale. It's really interesting stuff that skirts insurance companies.
   
   >Same with diabetes. Figure it out very early, start treatment and get people healthier, because now many who can barely afford to see a doctor are doing just what you say, having catastrophic insurance and waiting until there is a problem not easily fixed.
   
   Agreed, people need to focus on prevention. But I think the current mentality is misguided and focuses on band-aid fixes instead of correcting the root cause. The western lifestyle is horrible for our health. Very little sleep (another good read), very little exercise, and a horrendous diet. Get people 8+ hrs of sleep, get them moving around more, and get them eating more veggies seems like a much better plan than "here's a pill that will help your BP but will also give you bad side effects". Not against pills entirely, but it should be reserved for when lifestyle improvements aren't enough; supplemental use. These changes would free up healthcare resources which also lowers costs since we have an increasing amount of people in poor health and a healthcare system struggling to keep up with demand. Insulin is a different topic that I can't accurately explain in short, but here are 2 articles that begin to break into that discussion: 1, 2.
   
   >Much like a dentist. See one twice a year, catch things early and saves a ton of money compared to waiting until something hurts and spending a metric ton and going into debt.
   
   The experience may vary persons to person, but I personally don't have dental insurance (not saying it's for everyone). I pay out of pocket for yearly cleanings and it ends up costing less than dental insurance (tell them you'll pay cash upfront). I also focus on a good diet without lots of sugar and processed foods to support teeth health. Both are preventative measures, neither require insurance, and both will save me money in the long run.
   
   >On top of all that, prior to WWII, if you could see a doctor which was not nearly as readily available now, you didn't have expensive tests, or medications. The doc knew from what experience they had or it was simply palliative care.
   
   You are correct. However tech tends to improve in service and cost over time so while it may be more expensive, I don't think it has to be extraordinarily more expensive. Look at electronics. We get crazy new tech every year with all these new features, and every year, that same tech goes way down in cost, even after inflation. Many things we take for granted today were unattainable to everyone but the rich back when they first came out (cars, phones, computers, AC, etc).
   
   >but it simply is just a conservative vs liberal argument and goes no where.
   
   It often is, I'll agree there as well. I wish it wasn't, and I personally do not argue for either side because I have disagreements with both sides. I just want to provide a viewpoint not many people hear because I passionately believe that we're better off fixing our problems on our own (or at least at the local govt level) than relying on a massive bureaucratic central govt.
   
   >the overhaul of healthcare in the US which you or I are def not intelligent enough to do alone.
   
   I think the fact we can both dig in this deep and not resort to insults represents a minimum level of intelligence. And maybe this is blind optimism, but I also think the solutions aren't as complex once we start really digging into the root cause of the problem and fixing things little by little (easier said than done). I'm also willing to bet we have plenty of common ground, maybe not as much on solutions, but on what the issues are. I find that promising.

Allow me to recommend. The guy that wrote this book taught my EMB class. You'll never look at screening tests the same way again.