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In Overdiagnosed, H. Gilbert Welch, Lisa Schwartz and Steven Woloshin argue that as definitions of diseases broaden, so do the risks to healthy people

HYPOCHONDRIACS have never had it so good 鈥� or should I say, so bad? Medical diagnostics have advanced to the stage where if you look for a disease you will find it.

Consider the advances in imaging technology that have been made in the last few decades. Today, we have PET, MRI, CAT and ultrasound scanners 鈥� precision imaging machines that can reveal far more than old-fashioned X-rays. No polyp, cyst or ominous shadow evades their scrutiny.

With new developments in molecular imaging, we can begin to hunt disease in every cell in our bodies. Then we have genetic tests, which determine the probability of developing an ever-growing list of diseases.

On top of this, the threshold for many diseases, such as diabetes, hypertension and hyperlipidaemia, have continually shifted downward, becoming ever more inclusive.

All of this has led to what the authors of this book call an 鈥渆pidemic of diagnosis鈥�. Today, people don鈥檛 just have diseases, they have pre-diseases: pre-diabetes, pre-hypertension, pre-obesity. In the face of pre-disease, otherwise healthy people seek treatment for potential ailments that show no symptoms, and maybe never will.

We are all becoming the worried well, spurred on by doctors, patient advocacy groups, pharmaceutical companies and the media. 鈥淚s informing the well about their risks for disease really the road map to a healthy society?鈥� the authors wonder. 鈥淚s it healthy for the young to focus on their likely causes of death years before it occurs?鈥�

The book makes it clear that if a person has symptoms, they should get a diagnosis from their doctor. And, certainly, it recognises the benefit in diagnosing the silent conditions that often show no symptoms, such as hypertension.

But it argues against the constant changes to disease thresholds, which define more and more people as patients in need of medication or treatment. When, in 1997, the definition of diabetes changed from a fasting blood sugar level of 140 milligrams per decilitre to 126 mg/dl, 1.6 million Americans became diabetic at the stroke of a pen. Being classified as ill creates anxiety, and being treated with drugs, operations or other therapies can create unnecessary risk.

H. Gilbert Welch, the lead author, is no cheap contrarian, though. As a primary care physician in Vermont, he has seen the ill effects that come with treating patients too early, and he is brave enough to provide some of his own case studies as cautionary tales. Is this the beginning of a movement to change the entrenched view in medicine that no diagnosis can come too early? Probably not, but it is a courageous and carefully crafted argument from a deeply humane physician.