过度诊断
Overdiagnosed
H. Gilbert Welch · 初版 2011 年
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在骨质疏松症的判定标准被修改后，七百万美国女性一夜之间沦为了病患。20世纪70年代胎儿监护仪的普及，使被告知需要紧急剖腹产的女性比例增加了66%，但这并未改变婴儿需要重症监护的比例或婴儿死亡率。前列腺癌筛查的引入导致超过一百万额外的美国男性被告知患有前列腺癌，尽管各项研究在是否有少数人因此获益的问题上仍存分歧……
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如果你对“我们筛查癌症（以及糖尿病、骨质疏松等其他疾病）的能力，为何已经远远超前于‘判断治疗是否真正有效’的能力”感兴趣，我强烈推荐 Welch、Schwartz 和 Woloshin 合著的《Overdiagnosed》。目前医学界在某些疾病上面临一个尴尬期：我们甚至无法确定治疗带来的收益是否大于代价……
If you're interested in how our ability to detect cancers (and other diseases like diabetes and osteoporosis) has surged ahead of our ability to know when treatment is effective, I highly recommend Overdiagnosed by Welch, Schwartz, and Woloshin. Right now medical science seems to be at an uncomfortable phase with certain diseases where we can't be sure our treatments will have a greater benefit than the cost…
……有效地降低发病率和死亡率。如果你去做了体检而且一切正常，你就能松一口气、放下心来。不幸的是，这全错了。>最近有一本书解释了原因：《Overdiagnosed: Making People Sick in the Pursuit of Health》，作者是 H. Gilbert Welch、Lisa M. Schwartz 和 Steven Woloshin 几位医生。它全面解释了检查结果是如何让人“被生病”的，以及为什么去……
…effectively to prevent morbidity and mortality. If you get a checkup and everything looks OK, you can breathe a sigh of relief and relax. Unfortunately this is all wrong. >A recent book explains why: Overdiagnosed: Making People Sick in the Pursuit of Health, by Drs. H. Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin. It’s a comprehensive explanation of how test results make people sick and why visiting a…
……理解了一项检测的敏感性和特异性，你就能采取行动，让预期结果的效用最大化。在很多情况下，最优的做法其实是一开始就别做检测。《Overdiagnosed》是 H. Gilbert Welch 医生写的一本关于这个话题的有趣好书。他最近在《纽约时报》上发表的一篇文章能让你大致了解他的论点：http://www.nytimes.com/2014/11/06/opinion/an-epidemic-of-thy...
…understanding of the sensitivity and specificity of a test, then you can take action to maximise the utility of the expected outcome. In many cases, the optimal action is not to test in the first place. "Overdiagnosed" is an interesting book on the subject by Dr. H. Gilbert Welch. A recent piece by him in the NYT gives an idea of his thesis: http://www.nytimes.com/2014/11/06/opinion/an-epidemic-of-thy...