Book review: Overdiagnosed

Title: Overdiagnosed. Making people sick in the pursuit of health (2011)

Author: H. Gilbert Welch (with Lisa Schwartz and Steven Woloshin)

Publisher: Beacon Press, Boston

Overdiagnosed is an attempt to change the conventional wisdom - the prevailing paradigm - that early diagnosis is always a good thing and therefore that the best test is the one that finds the most disease. He shows us the downside of our attempt to make sure that nobody misses out on any potential benefit by failing to be diagnosed. He shows us that the dogma of early diagnosis is maintained by overestimated benefits and a general disregard of the harms.

How you die vs If you die

Which is more important: how you die, or if you die? Research in medicine often uses mortality (death) as an important outcome. Death (from any cause, so called ‘all-cause’ mortality) is easy to measure, it is not subject to misclassification, and it is the most important outcome for many conditions and treatments. Many researchers, however, favour ‘disease-specific’ mortality (only counting the deaths from the disease being studied) rather than all-cause mortality. The argument is that this measurement is more sensitive to changes in treatments that specifically target that condition (as there is less ‘noise’ from deaths from other causes). For example, it makes sense to measure deaths from heart disease if you are testing the effect of a treatment for heart disease. However, the use of disease-specific mortality can be misleading, it is arguably less important, and it results in an overestimation of the benefits and underestimation of the harms from many interventions.

Book review: Bad Pharma

Title: Bad Pharma. How drug companies mislead doctors and harm patients (2012)
Author: Ben Goldacre
Publisher: Fourth Estate, London

Ben Goldacre, a UK based doctor, has become a popular medical and science writer. His previous book Bad Science was a big hit, he has popular web and Twitter profiles, and he is a regular public speaker and newspaper contributor. His new book, Bad Pharma, specifically targets the problems with medicines. It does not restrict itself to the pharmaceutical industry (although drug companies are the main target), the book also details problems with government regulators, patient advocate organisations, doctors, medical colleges, governments, journals, universities, academics and even ethics committees. Fortunately, the book also offers solutions.

Limits to medicalization?

The character Syndrome from The Incredibles pictured a world where everybody had super powers: “because when everyone is super, no one will be”. If more than 50% of the population have depression, then what is ‘normal’? What if it was 75% of the population? Are we witnessing a gradual approach to a situation where we will reach the Last Well Person? Is a well person simply a patient who has not been completely worked up?