H. Gilbert Welch
1 Extremely Valuable Book
It is hard to put into words the importance of the book, Should I be Tested for Cancer? by Gilbert Welch, M.D., Professor of Medicine at Dartmouth Medical School. It is equally as hard to put into words the courage that it must have taken to write this book. The medical establishment does not look kindly on those who stray too far from the constraints of conventional wisdom. Those of us who seek only about the truth as it pertains to healthcare issues are greatly indebted to Dr. Welch for daring to do so.
I have been involved with health care issues for over 28 years. This book is a God-sent and is easily the most important book on this subject I've read in the last decade. Quite frankly, I couldn't put it down. It was given to me by one of my patients who, over the years, has known of my "healthy skepticism" towards many aspects of conventional medical practice, especially as it relates to cancer diagnosis and treatment. The book confirms many of the thoughts that I have shared with my "nontraditional" patients over the years.
It is never easy to be perceived as going against the grain of conventional wisdom in any discipline, especially one as emotionally charged as cancer. The author has performed an invaluable service to the many concerned people who dare to think for themselves "outside of the box." A simple perusal of some of the chapter headings reveals all you need to know about where the book is headed: "It is unlikely that you will benefit." "You may have a `cancer scare' and face and endless cycle of testing." "You may receive unnecessary treatment." "You may find a cancer you would rather not know about." "Your pathologist may say it's cancer, while others say it's not." "Your doctor may get distracted from other issues that are more important to you."
In Dr. Welch unemotional, factual writing style, we learn about such concepts as "false positives," "pseudo disease," the fallacy of "early detection," suspicious and unreliable "cure rates." We are introduced to the rarely recommended but legitimate treatment option of "watchful waiting" which, for many patients and some forms of cancer, may be the best course of action. We are told that how hard doctors look for prostate cancer affects how much they find. Did you know that there is a saying among doctors about prostate cancer: more men die with it than die from it? There are similar nuggets of wisdom about breast cancer, cervical cancer, and lung cancer. And did you know that you could easily become a victim of a deadly form of medical "political correctness"?
Here are a few snippets from the book well worth quoting:
"Tests can be wrong, people are made to worry unnecessarily, some are treated unnecessarily, and some are even harmed by treatment."
"I will argue that a decision to forgo cancer treatment can be a reasonable option."
"If the behavior of doctors and the public continues unabated, eventually every well person will be labeled as sick."
"Some believe that anyone who dies of cancer and wasn't screened would have been saved had they had a test. But that's not true."
"I object to the emerging mindset that patients should be persuaded, frightened, and coerced into undergoing [mammography, PSA tests, fecal occult blood testing]. There is today a certain "medical correctness" about screening - making patients feel guilty if they choose not to pursue testing. This is wrong." [emphasis added]
As Dr. Welch makes abundantly clear, this book is not for everyone. It is not for people for have a need for simple answers. We all know friends and relatives who, if told they have a "lump" somewhere on their body, need to "have it out" as soon as possible in order to restore a certain peace of mind. This book is definitely not for them. Rather, it is for those thinking individuals who are open to questioning the wisdom of traditional medical practices, especially as they pertain to cancer testing and conventional treatment modalities. For them this book is a definite eye-opener and may someday become a life-saver. Again, one can only admire the courage that it took to write a book of this magnitude.
I enjoy the give-and-take of discussing health issue with my patients. While I refrain from offering specific medical advice outside of my field of dentistry, I readily discuss health issues on a general level with selected patients. What I always suggest is that it is extremely important that they educate themselves in all aspects of healthcare - including cancer diagnosis and treatment - now, when they are healthy, so that when the day comes when they or a loved one are confronted with an important health issue, they can make an intelligent , informed, and unemotional decision. This book has greatly assured me that this is a sound, reasonable philosophy, and as such, I will be highly recommending this book to all those who want to be actively involved in their own healthcare decision-making process.
2 Highly recommended
This is a superb book. I recommend it to all adults and all students. It is written clearly and is easy to read. It is interesting with well researched facts, but also enjoyable and exciting because of the author's personal voice. It is an important subject and an important book. Medical school instructors, and even daring college and high school biology instructors might even cover this book in their classes. I know most students will keep their eyes wide open during discussion. What a contribution to society!
3 Excellent and timely!
This book has helped restore some sanity (namely, my own). After reading extensively about the value of mammograms and other widely used cancer screenings, I concluded that the benefit to myself as an individual was probably minuscule -- or perhaps even negative. But I seemed to be the only one who thought so. It all left me wondering: Am I missing something? Are my math skills really that bad? (Hey, I checked the numbers with my RPN calculator!) Am I just loony?
After reading this book, I was relieved to discover that the answer to these questions is no. Well, OK, maybe there are other grounds for answering yes to the last one, but never mind that.
I would recommend this book highly. It is exceptionally enlightening and useful, and very clearly written. It's also much needed now, with the drumbeat for testing growing louder every day. An ad in my local paper recently tried to terrorize women into getting mammograms by saying, "You may be dying and not know it." Subtle, eh?
4 What everyone should read.
This will be a short review as I am not an authority. Everyone in America should read this book, including all Doctors and Nurses. Taking what any one Doctor prescribes as indisputable is dangerous to your health. Second opinions should be the norm and not the unusual. This book could save a lot of stress and worry for people in need of health care. Dr. Welch performed a great service to the average citizen using todays health care.
5 Should I be Tested For Cancer,Maybe Not and Here's Why
"Should I be Tested For Cancer, Maybe Not and Here's Why." by Dr. H. Gilbert Welch is an eye-opening and empowering book for anyone facing the decision to undergo cancer screening and possibly become caught in the medical testing quagmire. I discovered Dr. Welch's book at a time when I was facing this medical dilemma myself. The book brings to light many problematic issues regarding the usefulness and validity of cancer screening and testing, which I believe most of us as consumers are not aware of. In particular, Dr. Welch makes the point that, for a variety of reasons, cancer screening/testing may not always be as beneficial as we the consumer have been lead to believe.
Dr. Welch's book provides a rational perspective to our society's fear of the threat of cancer. He offers the reader a wealth of information that I believe will help others to make a better informed decision when faced with the issue of cancer screening /testing and possible subsequent treatment.
I found his book to be very helpful in alleviating my feelings of fear and helplessness when faced with my own cancer scare. After reading this timely book, my wife and I feel we can be in a position to have a partnership in any future decisions we make with our physicians regarding the choice to undergo cancer screening and/or testing and treatment..
Roo Harris
Little River, CA
6 Clear Expose of The Cancer Industry
H. Gilbert Welch, MD, MPH, has written an unusually understandable revelation of the folly of testing for cancer in people with no symptoms. He explains how only a few people will benefit from common tests such as PSA, fecal blood, mammograms and others. He is enough of an insider to be able to explain the flaws in clinical trials being used by "authorities" to recommend extensive testing, and the lack of trials in some cases. The unneccessary biopsies, surgeries, radiations, chemotherapies for slow-growing cancers or even non-malignant ones are presented bravely. The uncertainty of testing is exposed where a positive for cancer may be wrong 1/3 of the time. And it is up to the patient to get second opinions.
The financial and legal pressures on MDs to test excessively are brought out. There is advice on talking or writing to your MD to indicate your unwillingness to undergo too many tests, and not to hold your MD liable if a cancer was "missed" - that is the big thing.
The deaths caused by cancer treatment are aired. This is something very few people, even MDs, know. Even when a treatment can cut the deaths from a particular cancer in half, most current treatments create non-cancer deaths, many of which will be improperly reported.
Welch is a special expert on the misleading nature of 5-year survival rates how they can rise because of early detection, yet with no change in the cancer plus cancer treatment mortality rate.
There are good explanations of how 5-year survival rates are calculated, how age-adjustments are made, how randomization for trials is done, and other things not even taught in medical school, but reserved for medical researchers. And quite easy to comprehend with clear figures and tables.
No errors that I can find; a really excellent book.
7 Cancer Testing Is A Two-Edged Sword
Dr. Welch has performed a great public service by writing this book. In response to the pervasive message that testing for cancer is always good for patients, Dr. Welch explains that the truth is not so simple. In fact, most people will not benefit from cancer testing, and there are serious risks of over-diagnosis and over-treatment associated our most common cancer screening tests. This book is clear, well written, and eye-opening. For anyone who wants to make an informed decision about getting a mammogram, or a PSA test, this book is a must-read.
8 Cancer Screening is Not Always a Good idea
For decades, the American Cancer Society and others have relentlessly campaigned for early cancer detection. And the campaign has been successful - the Journal of the American Medical Association recently reported that only 2% of Americans felt that there are too many cancer-screening tests. Despite this enthusiasm, expert panels of physicians and scientists, after careful reviews of the evidence, do not always endorse screening. Facing these conflicts can be distressing, particularly when confronting issues as serious as cancer.
This book offers insights that clarify the issues for patients and physicians alike. As the subtitle suggests, Welch is skeptical about screening, and his text challenges the establishment. However, Welch is not a medical outsider. He is a practicing physician, a Professor at the Dartmouth Medical School, the former editor of a medical journal, and a researcher who has helped reshape professional thinking in articles in the New England Journal of Medicine, Journal of the American Medical Association, Annals of Internal Medicine, and other key medical journals. Using the traditional medical literature, Welch raises some very challenging questions for anyone considering cancer screening.
Welch's book provides the reader with a new way to think about testing. He tells how cancer tests may identify disease for which there is no effective treatment, or for which the consequences of treatment are worse than the consequences of the disease. Welch explains why it may sometimes be better not to know you have cancer. In fact, many of us have conditions that will never affect us. In one section, he uses data from the pathology literature to demonstrate how fuzzy the definition of early cancer realy is - that different pathologists can examine the same specimens and come to different conclusions about whether cancer is present. Another section offers easy rules that clarify misleading reports of cancer rates. By walking us through the meaning of cancer statistics for individual patients, Welch clarifies what numbers should be important to individual patients.
The bottom line is that this book takes on a difficult topic with remarkable clarity. Dr. Welch provides tools that will help patients play a more active role in their own health care decision making.
Robert M. Kaplan is Professor and Chair of the Department of Family and Preventive Medicine at the University of California, San Diego School of Medicine.
