Who Benefits From Overdiagnosis? Pharma, Device Makers, Hospitals

H. Gilbert Welch. Courtesy of Dartmouth College

In recent weeks, we’ve seen the U.S.Preventive Services Task Force recommend that healthy men not have a PSA test, and read a new study suggesting that only about 3 percent to 13 percent of  women whose breast cancer was detected by a mammogram are actually helped by the test. In the case of both prostate cancer and breast cancer, test opponents argue, vastly more people are treated in ways that damage their lives than people who are helped by the tests. One study showed that for every life saved by prostate cancer treatment, 47 men are treated in ways that will probably greatly alter their sex life, not for the better. With breast cancer, a recent study published in the Archives of Internal Medicine suggests  that 1 woman per 1,000 healthy women screened over 10 years falls into the very small sample whose life is saved. Many others a treated in ways that cause pain, anxiety, and depression. The author of that study, H. Gilbert Welch, a professor of medicine and director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice, recently told BU Today who, in his opinion, benefits from the kind of overdiagnosis that does so much harm: “A lot of people: pharma, device manufacturers, imaging centers, and even your local hospital. The easiest way to make money isn’t to build a better drug or device—it’s to expand the market for existing drugs and devices by expanding the indication to include more patients. Similarly, for hospitals, the easiest way to make money isn’t to deliver better care; it’s to recruit new patients—and screening is a great way to do this.”

Read more in Welch’s book, Overdiagnosed: Making People Sick in the Pursuit of Health (Beacon Press, 2011), written with coauthors Lisa Schwartz and Steven Woloshin.