H. Gilbert Welch > Quotes

“Two decades ago the federal government invited 150,000 men and women to participate in an experiment of screening for cancer in four organs: prostate, lung, colon, and ovary. The volunteers were less likely to smoke, more likely to exercise, had higher socioeconomic status, and fewer medical problems than members of the general population. Those are the kinds of people who seek preventive intervention. Of course, they are going to do better. Had the study not been randomized, the investigators might have concluded that screening was the best thing since sliced bread. Regardless of which group they were randomly assigned to, the participants had substantially lower death rates than the general population—for all cancers (even those other than prostate, lung, colon, and ovary), for heart disease, and for injury. In other words, the volunteers were healthier than average. With randomization, the study showed that only one of the four screenings (for colon cancer) was beneficial. Without it, the study might have concluded that prostate cancer screening not only lowered the risk of death from prostate cancer but also deaths from leukemia, heart attack, and car accidents (although you would hope someone would raise the biological plausibility criterion here).”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“But multiple studies have shown what is labeled overweight (BMI between 25 and 30) is actually associated with lower death rate than what is labeled normal weight (BMI between 18.5 and 25).”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“It’s important to acknowledge the role of chance in health.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“I am often asked about three assumed benefits of mammography: less metastatic disease, less need for aggressive treatments, and important reassurance. Unfortunately, reviewing the actual evidence suggests that these “benefits” are limited or nonexistent.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“any one of us can draw the bad card of an aggressive cancer. Good people—doing all the right things—still get sick. It’s tempting to want to find something—or someone—to blame.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“No matter how many determinants of health we throw in the mix, we will never be able to perfectly predict who will experience good health.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“In 1996, the U.S. Preventive Services Task Force, the independent panel of experts that reviews screening tests, recommended against routine fetal monitoring.5 But according to their current Web site, fetal monitoring has become such an ingrained fixture of medical care that, frankly, the task force seems to have simply given up on trying to dissuade doctors from using it: Despite the lack of evidence on its positive impact on health outcomes and the 1996 USPSTF recommendation against its routine use, intrapartum electronic fetal monitoring in pregnancy has become common practice in the U.S. Based on currently available evidence, the USPSTF believes there would be limited potential impact on clinical practice in updating the 1996 recommendation. The”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“Of course, I’m guilty of oversimplification here. First, there are real-world legal concerns: doctors aren’t punished for overdiagnosis, but they are punished for failing to diagnose. So it’s hard for doctors to ignore incidentalomas. Second,”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“Patient stories of “success” are very powerful, but they can also be very misleading. Few want to raise the alternative possibility: the patient didn’t need the intervention in the first place—they were going to be fine without intervention, perhaps they would be even better. No one, particularly doctors, has any interest in raising the possibility that they went through all that for nothing.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The first question to ask is obvious: Is there good evidence of benefit? Good evidence means a randomized trial showing lower cancer mortality, not observations crediting turtles with higher survival rates. Frequently, the honest answer will be no. If so, I’d stop there. If benefit hasn’t been proven, I wouldn’t pursue the test—because harms are always part of the deal.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“To the extent that I have control over my cause of death, avoiding a heart-disease death, an aneurysm death, or a cancer death isn’t my top priority. I’m more concerned about suffering a lingering cognitive decline in a long-term-care facility. And”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“Of course, that’s crazy. Doll and Hill’s data from over fifty years ago are equally relevant today—no matter how or where we study the issue, the finding is the same: smokers are ten to thirty times more likely to die from lung cancer than nonsmokers. This makes smoking the most powerful modifiable risk factor for cancers that kill people. Spiral CT technology is detecting a very different category of lung cancer, small abnormalities that meet the pathologic criteria for lung cancer yet are not destined to cause symptoms or death. Spiral CT is causing a substantial amount of overdiagnosis.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“Given the number of small cancers they did find and the number that they reasoned they had missed...the researchers concluded that virtually everybody would have some evidence of thyroid cancer if examined carefully enough.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“One explanation is intellectual inertia: when we commit to one school of thought, it takes time to move to another. But it also takes time to do the research that overturns the prevailing mindset.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“You should understand that the only doctor that never has a role in causing harm is the doctor who no longer sees patients.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Patients could help by being a little less enthusiastic about scanning in general. In particular, they should avoid whole-body scans, which can open a Pandora’s box of incidentalomas. They could also be a little more hesitant about other scans and, when given the choice, choose the most anatomically focused exam to avoid stumbling onto things outside of the area of interest. A”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“In 1947, the World Health Organization formulated a definition of health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Now I’m having a heart attack. My baseline risk has just skyrocketed: now we’re talking about a 7 percent versus 9 percent risk of dying in the next thirty days. Unless death has become a desirable outcome for me—and at some point it likely will—I’ll take the 7 percent, thanks.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The only way to know if the screening is saving lives is by doing a randomized trial. It's easy to forget this and assume that if technology can find more cancer, it will save more lives. Marketers exploit this assumption. Don't fall for it.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“health. In 2011, they came up with this: the ability to adapt and self manage in the face of social, physical, and emotional challenges”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The World Health Organization, for example, currently lists ten determinants of health: income and social status, education, physical environment, employment and working conditions, social support networks, culture, genetics, personal behavior and coping skills, health services, and gender.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“back surgery doesn’t work that well for back pain.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The United States is one of only two countries in the world that allow direct-to-consumer advertising of prescription drugs”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“What is most certain about screening mammography in the United States is that it leads to a lot of false alarms: worrisome mammograms, and yet subsequent testing—another mammogram, an ultrasound, an MRI, and/or a biopsy—ultimately finds no cancer. For example, among 1,000 American women age fifty screened annually for a decade, how many will have at least one false alarm? Somewhere between 490 and 670. And 70 to 100 will be biopsied to prove they don’t have cancer.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“My judgment is this: arthroscopic surgery of the knee has been grossly overused in the United States. Ditto for back surgery. These surgeries shouldn’t be banned; they should be moderated. We are in the midst of a course correction—recognizing that the benefit of arthroscopic surgery is primarily for acute knee injuries, not chronic knee pain, and that the benefit of back surgery is limited to highly selected patients.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Embrace life. And don’t dwell on death—recognize that it’s part of life.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“Of course, different people will have different approaches to life. And individuals may feel differently about different diseases—particularly if some specific disease runs in the family.7 Adding to that variability is the fact that people may feel differently at different points in life. When we have major responsibilities to others, such as young children, we are likely to place more value on the “staying alive” side of the equation. But later in life, we may place more value on “staying well.” So we should expect that people will make different decisions about early diagnosis and that individuals’ decisions may change over time. In short, there is no single right answer.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“It is clearly not good to have very high blood sugar. It is clearly good to lower high blood sugar to normal through a combination of diet and exercise. But it clearly is not good to try to medicate diabetic patients until they have a normal blood sugar, because in doing so we will almost certainly cause some patients’ blood sugar to get too low.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care

“The right half of the table shows you data from 2001 on spiral CT screening on more than five thousand volunteers, some of whom smoked, some of whom did not.13 This study measured the rate of lung cancer diagnosis in smokers and nonsmokers. What it shows you is that with the advent of spiral CT, nonsmokers have about the same risk of lung cancer as smokers. It sure looks like the use of spiral CT has made cigarette smoking much better for you.”
― H. Gilbert Welch, Overdiagnosed: Making People Sick in the Pursuit of Health

“Some of it is simply luck.”
― H. Gilbert Welch, Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care