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The Shocking Dangers Of Medical Overdiagnosis & Overtreatment – Part 1

The Shocking Dangers Of Medical Overdiagnosis & Overtreatment – Part 1

Back when I was still in clinical practice, my newly pregnant patient Samantha, accompanied by her husband John, asked if I would order every medical test known to modern science in order to guarantee, beyond a shadow of a doubt, that both mother and baby would be healthy, chromosomally intact, genetically perfect, and immune to any risks of pregnancy or childbirth. Samantha was a young, healthy 28, neither Samantha or John had any personal or family risk factors, and from what I could gather, Samantha’s pregnancy was likely to be as low risk as they come.

I warned them that ordering unnecessary tests increases the risk of false positives, putting Samantha and the baby at risk of overtreatment. I also warned them that insurance would not cover unindicated testing, and they’d wind up with a whopping bill if I did order these tests. They didn’t care. Samantha was an heiress and they were willing to spend anything to ensure that Samantha and the baby would be healthy.

Because I’m well acquainted with the dangers of overdiagnosis and overtreatment and because, like all good doctors, I took the Hippocratic Oath that made me promise to “First, do no harm,” I didn’t feel comfortable ordering tests that were likely to cause more harm than good. Instead, I initiated a conversation with Samantha and John about how, as a mother and recovering control freak myself, I understand how much anxiety can spring forth during a pregnancy.  We’d all love to think we can test our way to certainty, eliminate risk, and guarantee a positive outcome. But as any experienced OB/GYN or midwife knows, the only thing certain about pregnancy and childbirth is uncertainty.

The Struggle For Control

When it comes to health, many people manage the fear, uncertainty, and vulnerability of the body’s fragility by going from doctor to doctor, begging for more tests. Surely, more tests are better, right? If we test for everything, we won’t miss anything, right?

Wrong.

It’s a known fact that patients are getting too many tests these days. And it’s not just patients who are guilty of requesting too many tests.  Doctors are just as responsible for the epidemic of overtesting.

recent New York Times article points out the harmful toll overdiagnosis and overtreatment may take on your health. What many don’t realize is that every time a test is performed, you run the risk of either falsely diagnosing, misdiagnosing, or overdiagnosing a disease.

What Is Overdiagnosis?

A false positive test result means the test comes back positive, even when the disease doesn’t really exist. It’s a function of the test itself, and every test has a specified false positive rate. Misdiagnosis, on the other hand, means somebody made a boo boo. Overdiagnosis means making a real diagnosis that needn’t be diagnosed.

Nowhere is the problem of overtesting more painfully obvious than in the quest for early detection and prevention of cancer, the disease Americans fear as their #1 health concern (#2 is Alzheimer’s disease for those who are curious.)

A study published in the Journal of the National Cancer Institute estimates that 25% of breast cancers detected on mammogram, 50% of lung cancers diagnosed by chest X-ray and sputum analysis, and 60% of prostate cancers diagnosed by prostate specific antigen (PSA) are “overdiagnosed.” The authors of the study define “overdiagnosis” as “the diagnosis of a ‘cancer’ that would otherwise not go on to cause symptoms or death.”

Overdiagnosis is not the same as a misdiagnosis, which implies that the pathologist made a mistake looking at the specimen under a microscope. Overdiagnosis of cancer suggests that the cancer exists, but that it could be argued that it is clinically irrelevant, that if left untreated, it would either regress spontaneously (we know this happens) or the patient would die of something else before the cancer caused death.

The authors describe how these overdiagnoses can harm patients and reduce quality of life, leading to medically unnecessary procedures, such as radical surgery and treatments known to predispose to future cancers, such as chemotherapy and radiation. The authors conclude, “Whereas early detection may well help some, it undoubtedly hurts others. In general, there is no right answer for the resulting trade-off—between the potential to avert a cancer death and the risk of overdiagnosis. Instead, the particular situation and personal choice have to be considered.”

What Should We Do?

So what’s a health conscious, cancer-fearing patient to do? I’ll be sharing my answer to this question in Part 2 of this blog series. If you want to be sure you don’t miss my answer, subscribe to get my blog via email here.

Until then, tell me what you think about all this. Have you or anyone you know been overdiagnosed or overtreated? Tell us your stories here.

PS. I’m speaking twice at the Take Back Your Health conference in the Washington DC area October 26-28. One talk is about how to run a successful business as a visionary healer and the other is about how we can expand our definition of health to optimize longevity and quality of life. I’d love to meet you in person, so please come if you can – and make sure you introduce yourself! I’m so jonesing to meet those of you who read my blog and would love the opportunity to hug you in real life.

Committed to your health,

Lissa

Lissa Rankin, MD: Creator of the health and wellness communities LissaRankin.com and OwningPink.com, author of Mind Over Medicine: Scientific Proof You Can Heal Yourself (Hay House, 2013), TEDx speaker, and Health Care Evolutionary. Join her newsletter list for free guidance on healing yourself, and check her out on Twitter and Facebook.

 

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Lissa Rankin

Lissa Rankin, MD is a mind-body medicine physician, founder of the Whole Health Medicine Institute training program for physicians and other health care providers, and the New York Times bestselling author of Mind Over Medicine: Scientific Proof That You Can Heal Yourself.  She is on a grassroots mission to heal health care, while empowering you to heal yourself.  Lissa blogs at LissaRankin.com and also created two online communities - HealHealthCareNow.com and OwningPink.com. She is also the author of two other books, a professional artist, an amateur ski bum, and an avid hiker. Lissa lives in the San Francisco Bay area with her husband and daughter.

7 comments

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5:04PM PDT on Oct 12, 2012

In my Golden Years (?) I am trying to take my health back from doctors overdiagnosing and over medicating me for depression. Nothing has ever worked for me and just found out it has been my thyroid!!

8:29PM PDT on Oct 11, 2012

Or what about all those HMO's in the 1980's that ignored or failed to tell people about conditions that could become difficult in late life leaving women to deal with these issues when they could have been initially dealt with in their earlier life.......

Or what about the issues of such conditions as Chronic Sinus conditions mostly caused by bad air and once they become chronic even those neti pots dont cure..nothing cures....and then we get ignored or they say have surgery on the sinus and that did not work for some and pay all that money for something that does not work....and then still get left with sinus infections because of a deviated not deviant septum...or whatever.

One of my doctors nurses and an ER nurse in Seattle acted like we all deserve these sinus infections...
the attitudes of nurses sometimes put me off..they believe gossip about people instead of even getting to know people .....

Or what about the quality assurance nurses that doctors offices and clinics should have in case a doctor very busy overlooks something .......

THE WAY IT IS TODAY ACCORDING TO THE PATIENTS RIGHTS AND RESPONSIBILITIES IT SAYS WE SHOULD RESEARCH AND KNOW WHAT WE ARE BEING TREATED FOR AND WE SHOULD KNOW OURSELVES..IN OTHERWORDS .....BE YOUR OWN DOCTOR...AND SAVE DOCTORS TIME BECAUSE INSURANCE COMPANIES DONT PAY ENOUGH NOW ..... ETC ETC ETC

I MUST SAY IT IS A STRESSOR TO MONITOR MYSELF MORE CLOSELY AND MY SYMPTOMS THAT I HAVE FOR NON LETHAL PROBLEMS THAT ARE IRRITATIN

3:37PM PDT on Oct 11, 2012

What about under diagnosis? There are those of us who have issues that some doctors don't even bother to check for. If something is considered "rare" some don't want to even consider it so we slip through the cracks. I have an appointment soon to see if I am a Zebra. It looks like I may have a genetic connective tissue disorder called Ehlers Danlos Syndrome. (The EDS community has adopted the Zebra as a mascot.).My father was very hypermobile and had other symptoms. I have had signs of it my whole life, yet no one even bothered to look for it. After my mom took me to the ER as a newborn because my legs "flopped around strangely" she was told I was double jointed and sent home. Being double jointed is a symptom! There are a few specialists with knowledge of EDS now but not many. Thank goodness my current doctors took me seriously and are sending me to be checked, but I'm in my mid forties and serious damage has been done now. I had no idea what a subluxation was, let alone that my joints subluxed constantly, or that it was abnormal. I have Osteoarthritis in several joints and experience pain in joints I didn't even know were there. So please don't count those of us out who have not been diagnosed with issues because of misinformation and lack of knowledge.

8:21AM PDT on Oct 11, 2012

it seems like every person I meet "has diabetes" ......young..old, fat, thin.....could this really be true? Or are they just being told this? I really wonder.

7:35AM PDT on Oct 11, 2012

Navigating the waters of our medical system is just as dangerous as sailing in shark infested waters. It pays to do a lot of self-research, ask a lot of questions and not rely on everything the doctors say, all the time.

1:09PM PDT on Oct 10, 2012

thanks

11:40AM PDT on Oct 10, 2012

Well said. A good doctor will know when to hold back from overtreating a patient. We need to make sure that our liability laws allow doctors to exercise this intelligent self-restraint rather than force them into the practice of "defensive medicine."

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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