73: The Aggressive Mission to Find Cancer is Going Too Far? with Dr. Gilbert Welch from The Dartmouth Institute

H. Gilbert Welch, MD, MPH

An internationally recognized expert on the effects of medical screening and over-diagnosis

Dr. Gilbert Welch’s work is leading many patients and physicians think carefully about what leads to good health. For Welch, the answer is often “less testing” and “less medicine” with more emphasis on non-medical factors, such as diet, exercise, and finding purpose in life.

Welch’s research examines the problems created by medicine’s efforts to detect disease early: physicians test too often, treat too aggressively, and tell too many people that they are sick. Most of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, breast, and prostate cancer. He is the author of three books: Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015), Overdiagnosed: Making People Sick in the Pursuit of Health(2012), and Should I Be Tested for Cancer? (2006). His op-eds on health care have appeared in numerous national media outlets, including the Los Angeles Times, The New York Times, the Washington Post, and the Wall Street Journal.

Welch is a professor of medicine at the Geisel School of Medicine, an adjunct professor of business administration at the Tuck School of Business, and an adjunct professor of public policy at Dartmouth College. He has initiated and taught courses on health policy, biostatistics, and the science of inference.

In this episode, the following topics are discussed:

• overdiagnosis is about how its found, and is a side effect of screening
• when screening for early forms of cancer
• some cancer is never going to cause the patient problems
• some cancer never becomes clinically evident
• we are looking so hard for cancer, that there is more than is possible
• birds, rabbits, turtles
• can’t fence in birds or aggressive cancers
• rabbits you can catch if you build enough fences
• turtles aren’t going anywhere anyway
• certain organs have a lot of turtles, prostate, lung, thyroid, breast
• ovedrdiagniosis only occurs when we are trying to look for early forms
• screening can benefit, but also cause harm
• breasts, prostate, and thyroid carry a lot of cancers. 
• overcoming cancer phobia, and reducing patient anxiety. 
• the best test is not the one that finds the most cancers, the best test is to find the ones that matter
• paradigm shift is happening in regard to cancer. 
• liquid biopsies, looking at biomarkers
• CA125

NOTES

H. Gilbert Welch, MD, MPH

Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015)

Overdiagnosed: Making People Sick in the Pursuit of Health(2012)

Should I Be Tested for Cancer? (2006)

Patient Resources

American Thyroid Association