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.

A 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,

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19 Comments

  1. Vivianne Bentley

    I have recently decided not to go for the breast cancer screenings that I was exposing myself too every 2 years. Am interested in your perspective on this. Do we stop altogether which is what my body is telling me to do, or continue but less frequently. My family live in the UK and my mother who is going to be 90 soon does no screenings and never has. My sense that preventitive medicine is much more of a North American model and while has some advantages, I am sure, it does contribute to the issue you are discussing in your blog.
    Much blessings to you.
    Vivianne

    Reply
    • Amanda Downing

      Great Question Vivianne!

      Reply
  2. Lissa Rankin, MD

    Great question Vivianne. This blog series has four parts, so stay tuned and make sure you’re on my newsletter list, because one of the blogs guides you through a step by step process regarding how to make decisions about screening tests.

    In short, discuss it with your physician, but ultimately listen to your Inner PIlot Light- that wise part of you that just knows what’s best for you.

    Personally, I got a screening mammogram at 40 and am now 43 without having done another. I don’t yet know what I’ll do personally when I’m older, but for now, this feels like the best plan for me…

    With love
    Lissa

    Reply
  3. Angela

    This happens quite often with elders in the long-term care setting. As I was watching the presidential debate last night and listening to the proposals for medicare reform I wondered, “Why doesn’t someone ask US?” We are in the trenches, on the floors of nursing homes, passing meds, calling the docs, doing treatments and booking appointments with specialists as we are ordered to, for our elderly residents.

    I am a licensed nurse and I work on the dementia unit of a nursing home. There are many examples of what I think are not only over treatment but poor use of taxpayer money, and health”care” (let’s rethink that word) without compassion.
    Mrs. J is 98 years old, can no longer walk or control her bladder or her bowels. She cannot feed herself nor speak. She does not recognize her family. She is loved and very well cared for very tenderly by the staff and by her family. Because she has atrial fibrillation, she is at risk for a stroke and the doctor has ordered warfarin to help prevent stroke. Once a week, sometimes more depending on her lab results, a lab tech comes in to her room at about 5am, wakes her up and begins to stick her with a needle to draw blood. She always jumps, or pulls her arm and vocalizes as if she is in distress. Occasionally she will have a bruise on her hand where it had to be held still for the lab tech. She has to have this done to measure the effect of the warfarin she takes to thin her blood. Warfarin can be very dangerous and must be monitored very closely to be sure the levels in her blood are therapeutic. So, later in the day the lab calls the very busy nurse who has about 20 other residents to attend to, reports the result and the doctor is called, Orders are written (often in 3 different places), faxed to the pharmacy, noted, and follow up lab is booked for several days later. Think of the billing, paper, ink, staff hours, equipment, transportation, electricity needed for all of these steps, procedures and staff-when if we had a conversation with Mrs. J twenty years ago she would have said “Oh I would never want to live like that! Just keep me comfortable!”
    Multiply this by 20 or so patients like her in this facility, multiplied again by the number of similar facilities in this city, then in the state, and the entire country…. One of the doctors at the facility cited a statistic for daily low dose aspirin therapy (with no blood work needed) instead of warfarin as having only a slightly higher risk than warfarin treatment.
    I see g-tubes inserted into patients the same age and in the same condition, bone mineral density testing done for those who are chair bound..
    I realize the terrible burden to a family member when he or she is charged with declining a treatment for a loved one that may lead to an earlier death than if the treatment was put in place. President Obama was pounced on a few years ago for suggesting families have a conversation with their elders, (remember the killing granny political nonsense?) but he was right on the mark.
    As for the couple in Lissa’s post, what would be so terrible if the child wasn’t perfect? Children with disabilities can often be a priority-straightening, eye-opening blessing.
    As for myself, I have skipped several recommended mammograms and my insurance company has notified my doctor of this. (And yes, she scolded me.) I am 50 and I have had two. I know our breast tissue is only exposed to the tiniest amount of radiation (a known cause of cancer!!) but isn’t there always the chance of human error, or mis-calibration of the equipment…?
    It is one of my dreams to see, or hopefully be part of a wholistic medical practice that has as its mission to create a creative community of patients and staff with the goals of well being, prevention and cure.
    THERE! Long-winded, but as you can see, you’ve touched a nerve.

    Reply
    • 8Pi

      You have to wonder on what scientific basis your doctor “scolded” you for refusing mammography. Good for you for not submitting to tests that, as we all know, have caused more women – of all ages – to be subjected to terror, and to grossly invasive biopsies, etc. Getting a mammogram “just because” has not saved more lives. As to equipment – I have had a cardiologist and the technician proceed with a stress echocardiogram even after – finally figuring out – that the machine wasn’t working properly. You’re lying there – what do you do? Well. You run like hell is what you should do, but it’s tough, even for tough broads. It didn’t matter to any physicians seen for follow up. (And what valid results there were, weren’t shocking). They all acted – should I say “colluded” that it was just fine and dandy to move to interventions despite a broken machine which couldn’t even yield an ejection fraction percentage. That was one year ago. I didn’t do anything. Now, I’d like an echocardiogram, just so I could know how my heart is functioning – but I haven’t figured out a way to get the results without their being interpreted by these ____ fill in the blank. Of course, that isn’t possible. I’m only considering having a plain echocardiogram due to the lack of information last time around. 95% chance I’ll cancel the appointment, and let things fall where they may. (I have not had a documented MI).
      There is nothing you have said that isn’t vitally important as to overdiagnosis, overtesting, testing throughout ones days…and the need for people, (me included), to right up the end time plan and make sure it is legally done. Thank you.

      Reply
  4. Lissa Rankin, MD

    I totally agree with you Angela. Thanks for sharing your stories. And yes, the nerve is tender for many. I share your vision or a wholistic way to practice medicine and a new way for docs, nurses, patients, and other providers to be in community with each other, not from a fear-driven place, but from a place of a deep knowing what really matters.
    xo
    Lissa

    Reply
    • Angela

      Yes- so well said!

      Reply
  5. Leigh

    Thank you, Lissa, for this series. I feel like we have, as a society, confused screening with prevention, especially in the U.S. As patients we turn our health over to physicians and only feel “safe” if they are doing something. We seem to approach this from a very fear-based place. Many people approach health care as if they are preventing the disease by getting screenings, then wait in fear for the diagnosis. I watched many of my relatives live this way, sometimes only being satisfied when a doctor “found something.”

    Preventative care, to me, is so much healthier, and self-love and self-care even more so. I believe that many of the illness we develop are our spirit’s way of getting our attention through our bodies. I know this is the case for me. I feel we will be better off when we start focusing on our own health and happiness, and living our lives now.

    Reply
    • Angela

      I think some of it has to do with providers feeling they need to cover themselves in case they are sued…? Also, the state DPH will scrutinize medical records, as they should,and come back to the provider with “What did you do about this lab, or complaint, or symptom…?”
      I agree Leigh, it is from a fear-based place that we receive/order all these tests. Just look at all the fear mongering on the news, in pharmaceutical ads, headlines, tv shows.

      Reply
  6. Edie

    I was diagnosed with MVP ( Mitros Valve Prolapse) in 97. I was required to take antibiotics every time I had dental work. I eventually stopped taking the pills in 2000. I still continued to have an echo cardiogram once a year.
    At my visit this year. I was told I never had MPV to begin with. So, I worried, took pills and unnecessary tests all these years for nothing. It turns out that I don’t fit the new guidelines. Oh, I did confirm the results with another Cardiologist just to be sure. The results were the same.

    Reply
  7. Lissa Rankin, MD

    I so agree Leigh. Prevention is more about making sure we are living in alignment with our own personal truth than whether we’ve had a colonoscopy. The truth is that happy, whole people rarely get sick- and when they do, they often use it as a sign from their wiser self that something is out of alignment- then they get better quickly. Our bodies are beautifully equipped with natural self-repair mechanisms. But there’s scientific proof that those mechanisms don’t function well when we’re living in fear…

    And Edie, I too had a heart murmur in the past. And even though my echo was normal, dentists insisted I take drugs. So I started lying to them, telling them I didn’t have a heart murmur.

    We shouldn’t have to lie to avoid unnecessary and potentially risky treatment.

    Reply
  8. Kat

    Due to a lack of insurance, I *know* I haven’t been overdiagnosed or overtreated. Au contraire; our doctor, also a dear friend, would like to run several more on me to confirm his highly-educated evaluations. We did manage to scrape up the cash to get me tested for mold when he became convinced mold toxicity was behind many of my problems. He’s an expert on the subject, so no surprise when the urinalysis came up positive. We’re now out of the moldy environment, he’s got me on a detox program, and I feel as though my odometer is running backwards! 🙂 And since I’m now less than a year away from Medicare, that’s a nice feeling to have!

    But I’ve seen it happen, and I suspect that’s what may have happened to one of my dearest friends. She’s a decade younger than me but is almost bedfast now, a condition made worse by the excess weight several of her medications have added in an appallingly short time. And there’s nothing I can do for her except hold her in my heart, and run errands when I can. Can’t get her in to my own doctor, because she’s moved and now lives too far away. I don’t know if she’ll ever recover the athlete I first knew.

    Bad enough if she’s in this sort of shape as a result of “normal” causes. But if some of them were in fact overdiagnoses….

    Reply
  9. Kayll

    Hi Lissa,

    I’m so glad you wrote this post and I look forward to reading the rest of it. For my health information, I like to follow Dr. John McDougall and his suggestions which can be found on his website. He talks about how tests and screenings have 100% change for harm and 1 out of 1,000 chance for a benefit.

    As I’m sure you are well aware, it takes years for cancer to grow large enough to even be detected. By that point, it’s not “preventative”, but catching something that has likely spread throughout your entire body. And as you mentioned, how many cancers have spontaneously been “cured” or gone into remission we will never know. Our immune system, when allowed to do its job, is a powerful wonderful thing. Yet chemo and radiation already attack a weakened immune system that couldn’t find the cancer in the first place.

    Mike Anderson has also done a lot of research for his book, Healing Cancer From the Inside Out, which reveals the lies and “number fudging” the cancer idustry does to push their latest chemo treatements. Sadly the placebos (ala doing nothing) have a better recovery rate of most of the “hot new cancer drugs”. Yet absolute numbers are rarely published because it doesn’t sell these dismal chemo drugs that do more harm than good. Some chemo drugs are known to cause cancer as well. So a patient is “cured” of one thing and another cancer appears years later.

    I also look to the Physicians Committe for Responsible Medicine for my information as well.

    It saddens me as I learn more, it seems to point out the flaws in the allopathic approach in to treat the symptoms rather than the cause of most diseases. What we put into our bodies along with the environment we live in play a much larger role, it seems, than genetics.

    And since I follow Martha Beck and many of her coaches, I do think our bodies will respond negatively is we are off path. Or really respond “positively” to tell us we aren’t doing the right thing. Is cancer really evil and insidious?

    Are any of these ailments bad or just results from what we are doing in our lives? Eating garbage. Working in a job we hate. In a suffocating relationsihp or living a toxic lifestyle. Our amazing bodies do they best they can to keep us alive.

    And you mention your inner pilot. I think people know when something is amiss. If you never eat any fresh food and rarely go to the bathroom, you shouldn’t be surprised to find problems in your colon.

    Obviously this is a topic I also feel strongly about. I provided resources to a dear friend who was recently diagnosed with breast cancer. She has completely changed her diet and lifestyle and feels more in control of her health/life. That is my goal – to walk my talk and be the change I wish to see in the world.

    Thank you for all you do! 🙂

    Reply
    • Anna

      Read “World without Cancer. The story of vitamin B17” by G. Edward Griffin, or watch: httpss://youtu.be/tPADSv3XAv0

      Reply
  10. Lissa Rankin, MD

    Kayll,
    I’m increasingly with you on all this re: screening tests. I have three more posts in this series that I’ve written based on my recent research for my next book The Fear Cure, so stay tuned. I’d love to hear your feedback.

    Thanks also for these resources. I’m not familiar with some of this work, so thank you- and thank you Universe- for sending me perhaps where I next need to research and continue to open my mind…

    Much love
    Lissa

    Reply
  11. Lika Saliscente

    I am fully in agreements, that you don’t fix what’s not broken. So, if there is low risk, there is no need for extra testing.

    On the other hand, it’s like with me, I just don’t feel like my doctors take me seriously. I’ve had pain problems for over 20 years. It’s become chronic to the point of 24/7 about 15 years ago. In the last 12.5 years, I’ve been to 25 doctors, soon to be 26, and they can’t give me anything but a head scratching and a shrug, and tell me there’s nothing they can do.

    Mind you, I’ve had countless x-rays, 2 MRI’s, 4 rounds of PT, 5 chiropractors, breast reduction, massage therapy, and pain management, and none have worked. I am high risk for lupus, but that isn’t looked into. There are TB issues in my family and that hasn’t been looked into. Structurally, everything looks fine, so they don’t explore other options.

    Another time, when I was pregnant for the first time, I had a lot going on. SEVERE pre-ecclampsia. I had double or higher than my usual text book blood pressure, and had edema so bad that I couldn’t fit into any of my clothes. I was also toxic, and spilling proteins into my urine. My OB/GYN would not send me to a specialist nor help out with any resources. Being in poverty, paying out of pocket was not an option. My mother, an RN, came with, and barely spoke up. I ended up having an abruption, where the placenta pulled away from the uterus, thus cutting off life support to my 33.5 week gestation baby. I lost him. My first child. My mother’s first grand child. Both my doctor and my mother seemed to know that with my symptoms, that this could have happened. I also nearly bled to death. yet my life, much less my baby’s life wasn’t worth pushing for a specialist.

    All I know is, IV fluids and liquid antibiotics, even for a short time as in 24 hours can lessen the pain, and when it lasts more like 48 hours, I’m pain free for weeks. Yet no doctor has looked into this. so while sure, it’s all good that you don’t test what looks normal, but, everyone seems to be afraid of doing the testing needed when there IS a need.

    Then, worse yet, all people can tell me is good luck, or that I’m lucky I don’t need surgery because structurally, I’m fine… Yet I don’t have a diagnosis, my pain is worsening by the day, I’m barely able to perform my home care aid job working 1 on 1, and I can’t get a diagnosis. The economy is so terrible here that no, quitting and looking for something else is NOT an option, unless I’m willing to become homeless, and then my ex gets my son.

    Reply
  12. Michelle Medina

    And I can vouch for Lissa that she gives fabulous hugs! Lol.
    Seriously, thank you for the post, I’ve been trying to get something worked out myself and just had a catscan done today. . . how fitting?

    Reply
  13. Matteo Trevisan

    It happened to me. I’ve been studying abroad, i was living alone for the first time distant from my family, after a month there I started having hemorrhoids probably caused by stress, unhealty life, unhealty food, and so on. At the beginning I ignored the problem thinking that it has to be just momentary, also I didn’t know were to go to find a doctor for a simple visit… one day I had to take a bus, to go to the hospital and they sent me with urgency to surgery room. The problem wasn’t going to be better also after the operation, one day when I was studying in the library I had my first panic attack but I didn’t know it was panic, I was thinkin’ it was something physical, so started struggling me trying to find what I had. After a month I started to have huge pain in the penis, went back to the hospital and an idiot… I’m sorry… a doctor, told me that probably I had the peyronie disease and I had to suffer pain for two years, my penis had to bend at 90 degrees, and there were no solution in medicine, the only thing to do after two years of pain have been to remove the penis’s skin, to cut it, to cut out a piece, and to reattach it shorter. You can immagine how a 22 years old boy suffering from anxiety from before could take a similar diagnosis. Came back to my country (italy), I went to see a specialist that done another wrong diagnosis, asked me to do a bunch of unusefull tests, gave me unusefull medicines and so on… I was telling to doctors that surfing the internet, and reading books of medicine probably I found the right diagnosis but, in the beginning, they were saying that my diagnosis was impossible.
    So i finished again in the emergency of an hospital with the symptoms of an heart attach, there they told me that it was just a huge massive panic attack.
    I went from doctor to doctor, and no one was able to give me a diagnosis on what I had, some doctors simply told me “I’m surrended, I’m not able to understand”.
    I spent an year having every kind of psycological disease. In the end, I went to see an old, really renowned doctor, spent a lot of money for a visit but I didn’t care. He done the exact same diagnosis I personally done an year before without being a doctor (okay I’m a doctor now but not in medicine 😛 ), just reading medicine books, and so it was really nothing to be really worried about. I just had to take the right cure and be patient. He said also “why the hell they made you do all those tests?” they were all obviusly unusefull and the diagnosis easy to do just taking a look.

    So in few months, with the right cure I solved the physical problem. I restarted living quite well, but right now I still have sometimes fear about human weakness, death and pain. That’s it, sorry if my english is not good enough.

    Reply
  14. Ronald123

    Hi Lissa. You write: “A study published in the Journal of the National Cancer Institute estimates that 25% of breast cancers detected on mammogram, […] are “overdiagnosed”.

    I’m afraid this is an understatement, as the following study demonstrates (httpss://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320224/): “Therefore, for every 100 nonpalpable cancers found through mammography alone, 54 would presumably have gone away (174 / 324 × 100 = 54%).”

    Conventional medicine is fear based and, in cooperation with ‘mainstream media’, it does an excellent job of keeping people distrusting their own bodies natural ability to deal with ‘dis-ease’. Science (which doesn’t work independent at all) picks and chooses those theories that serve this same purpose (evolution theory vs Intelligent Design, Pasteur’s Germ theory vs Bechamp’s ‘terrain theory’, etc.) and then continues to put new layers of similar theories on top of the already existing ones (all having one thing in common: they keep the population dependent on mainstream science/medicine/etc.). It’s a vicious circle…

    Reply

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