In the USA, medical expenses are higher than any other country. In today’s meeting, we will discuss just one aspect of why medical expenses are too high… too much Over-diagnostics. Over-diagnostic occurs when individuals are diagnosed with conditions that will never cause symptoms or death.
Conventional wisdom is that more diagnosis means more treatment, and more treatment means better heath. But, it is also true that more diagnosis may make health people feel more vulnerable and ironically, less healthy.
The trouble is that doctors don’t know if an individual has been over-diagnosed unless that person forgoes treatment, lives the rest of his or her life symptom free, and dies from some other cause.
In the past, people didn’t go to the doctor when they were well – they tended to wait until they developed symptoms. Since doctors don’t know who is over-diagnosed and who is not, over-diagnosed patients tend to get treated. But, an over-diagnosed patient cannot benefit from treatment.
· The rules have changed. Thresholds are lowered for hypertension, diabetes, cholesterol, and osteoporosis to make more people “Patients”. Diabetics Example: Treating people with "mild" blood sugar elevations are the least likely to gain from the treatment - and the most likely to be harmed.
·Doctors can see more “abdominalities” – Examples: CT scans can see a very small cancer that may go away on its own. In people without knee pain or a history of knee injury, about 40% of people have meniscal damage in their knees when scanned by MRI.
·Doctors look harder. Screening is offered and recommended. Example: In the last 30 years, Thyroid cancer and melanoma diagnoses have doubled, but the deaths for both cancers have remained the same (per 100k people). Screening has both benefits and harms, for example: Among 2,500 women age 50 who have a mammograms every year for 10 years, 1 or 2 breast cancer deaths will be avoided, but 1,000 women will have at least one false positive result and 500 women will have a biopsy. Five to 15 women will be overdiagnosed and will receive unneccessary treatment for breast cancer.
·Doctors stumble onto “abdominalities”. Example: Of every 10k CT exams, at least 1k will have incident abdominalities which will never progress to cancer, but 1 or 2 will. Even if five incident abdominalities turn out to be clinical significant, that leaves 995 overdiagnosed patients.
- Since most people who are tested will never get cancer, most people can't benefit from testing! Others will die from cancer despite testing because tests tend to miss the fastest growing and most deadly cancer.
- You may have a "cancer scare" and face an endless cycle of testing - some of which are invasive, unpleasant and risk serious complications.
- Screening cause people to receive unnecessary treatment. Some cancers don't need treatments... because the cancer may grow so slowly that people will die of other causes long before their cancer causes symptoms, or the cancer may not grow at all.
- Engaging dialogue between the doctor and patient about health risks & habits is more difficult. The more time the doctor spends on testing, and following up on abnormal test results, the less time doctors have to spend with patients discussing patient conserns and on what really matters to be healthy. Patients are looking for pills to keep them well instead of making changes in their lives that, evidence shows, to be far more beneficial.
Over-Diagnose: Making People Sick in Pursuit of Health. By H. Gilbert Welch M.D.
Should I be Tested for Cancer? Maybe Not and here is Why. By H. Gilbert Welch M.D.
Over-Diagnose: Making People Sick in Pursuit of Health. H. Gilbert Welch M.D speaking.
Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening.
Please read at least one of the books or watch the video before the meeting.
(If you want to suggest a topic for a future small group meeting, when you RSVP indicate what topic.)
The format: Small group discussion for the fun, quick thinking challenge we love... After a little preparation time, two volunteer teams will then take to one side of the table or the other to argue the for and against case.
A unique, informal take on the typical debate, you will be seated at a table giving you plenty of opportunity for smaller group discussions and a chance for everyone to have their say. The evening is structured with plenty of breaks for drinks and food.
The ideal way to meet new people, enjoy intelligent conversation over a few drinks.
If you're tired of easily offending people with your craving for a good debate or simply want to discuss the important topics of the day outside of the office without being told its not the time or place, then this is the event for you. If you enjoy being a part of challenging and interesting discussions then this is the event for you.
A Devil's advocate is a way of challenging a position or perspective about a topic about which there is debate by arguing for something you do not necessarily agree with. If we are not evenly divided on the issue, we will ask for someone(s) to play Devil's Advocate.
Please arrive at 7:15pm for a 7.30pm start.
These "small group discussions/debates" are best with a not too few people and not too many people at a table to give everyone a chance to be a part of the discussion while at the same time getting a diverse number of opinions.
$1 entry to help pay for the group.
Format of the meeting:
Tables of 6 to 7 people each for small group debate/discussion.
- Start with each person, at their optional, to say what is your viewpoint is, or what you're looking to learn.
- There will likely be two or three general positions/viewpoints.
- If most people agree, than we will ask for volunteers to take a Devil's Advocate position.
- Initially, everyone will have an opportunity to discuss why your position/viewpoint is best. - Then, everyone will have an opportunity to argue the “for and against” case. This is perfect for novice debaters, those of you who haven't debated for a while, or people that simply want to give it a go.
- After the “for and against” discussion and rebuttal, any semblance of a "semi-formal debate" would disappear and it will be a conversation.
- There will be no "debate rules" other than be nice. It will be very casual
Look forward to seeing you there.
If you are taking a MARTA train to get here, the restaurant is exactly 1/4 mile east of the MARTA Sandy Springs station in the REI shopping center.