Overdiagnosed: the book

Dr. H. Gilbert Welch is on to something with his new book Overdiagnosed: Making People Sick in the Pursuit of Health. Regular readers of the Health Business Blog won't be surprised to read that I endorse his skepticism of widespread screening and share his concerns about the implications of false positives. There's a good interview with him in today's Boston Globe. Key takeaways:

• Early detection isn't all it's cracked up to be
• Treatment benefits generally outweigh harms for those who really are sick, but over-screening causes lots of healthy people to get treatment that may harm them
• 'Better safe than sorry' sounds good, but "It's not as clear what the safest strategy is as people might assume"
• Definitions of common conditions such as diabetes, high blood pressure, and high cholesterol have been revised over the years to encompass more and more people who may not really deserve those labels
• The risks of annual mammogram screening should at least be considered by women before deciding to undergo them

I'm encouraged to see that serious authors are taking on this topic. It's likely to help shift the general public's thinking away from the facile and dangerous idea that more care is always better and anything less is rationing. It actually makes me optimistic that over time this change in mentality coupled with greater cost control incentives for patients and providers, will help us stop the rise of health care costs and eventually drive them down.