Home About Me My Books FAQ Reviews Essays etc. Space Miscellany Contact

This is part of the background information by Sylvia Engdahl for her science fiction novel Stewards of the Flame. If you don't see a menu on the left, please click here and then on "Medical overtreatment."

Overtreatment in Medicine Is Beginning to Be Recognized

At the time my article below was first posted (the fall of 2007) the belief that many standard medical tests and treatments are unnecessary or even harmful was rare enough to be called heresy, and very little was published expressing this point of view. Since then, increased attention has been paid to the harm caused by medical overtreatment and a number of books and articles about it have appeared, as well as organized movements toward change. Moreover, it has been pointed out that a great deal of unnecessary testing and treatment is done because patients demand it, sometimes against their doctors' best judgment. Although it is still common for doctors and hospitals to urge unnecessary tests, procedures, and drugs because they are conventionally, if erroneously, viewed as beneficial -- and in some cases, because they are financially profitable -- the fundamental problem is the outlook of society as a whole rather than that of the medical establishment. (Which is true of the fictional society portrayed in Stewards of the Flame, too, where the dystopian government run by medical authorities has the support of the voters.) Hopefully, the ever-increasing cost of medical care will wake people up if nothing else does. Society will never be able to afford medical care for all those who need it as long as so much is spent on unnecessary and sometimes-harmful care for those who do not.


The dogmatic medical establishment in Stewards of the Flame is assumed to be monolithic, with no deviance from the official view on any health issue except on the part of the protagonists -- several of whom are doctors -- who reject it in its entirety. In our own much larger and more heterogeneous society, where supposedly freedom of opinion prevails, there is much less uniformity of opinion, right? Wrong! Yes, there is controversy about the details of effective treatment, but very little on the major issues. Doctors are free to express differing views and a few of them do, but for the most part nobody listens, at least nobody who counts as far as determining what is likely to happen to the average patient is concerned.

There is, to be sure, wide attention given to complementary medicine (which is used along with conventional medicine) and alternative medicine (which is used in place of it). A recent survey showed that 36 percent of adult Americans use some form of one or the other. These are considered heretical by the medical establishment, which has succeeded in getting them excluded by law from the recognition and financial benefits accorded to medical practitioners by the government. However, they are not what I mean here by the word. I don't include them in my discussion because I personally don't think they have any healing effect apart from activating the self-healing powers of the mind in people who believe literally in the metaphorical explanations they offer for their success. That, of course, is no small achievement, and I certainly support people's right to have access to such practices without government interference. But I give no credence to them myself.

The difficulty is that it is very hard to find material that's critical of conventional medicine that doesn't also promote alternative medicine of one kind or another. There are many books and innumerable Web pages that challenge prevailing views of orthodox treatment, but they turn out to argue for herbal remedies, nutritional supplements, and so forth -- in many cases they are actually selling them, which is a case of the pot calling the kettle black when they complain about the pharmaceutical companies' motives for promoting prescription drugs. Few writers are willing to declare that "standard" medicine often does more harm than good without offering some alternate cure. In the case of the books, this is understandable, because ordinarily publishers don't issue such books; they don't sell well. The public wants to be told how to preserve, or regain, health. Doctors want to treat people; they couldn't go on practicing if they lost faith in treatment's effectiveness. I myself -- and I think many other individuals who avoid the health care system -- believe that it is better to do nothing about a health problem than to do the wrong thing. This is definitely a minority view, and is rarely expressed.

I go to doctors only when I have a serious illness for which there is an effective treatment. This has happened several times in the past and I have received excellent care; I don't doubt the skill and dedication of those who provided it. Recently (since writing the novel) I developed a condition for which there is some medication that's the lesser of evils, and other drugs and procedures that in my opinion are not, and which I therefore refused, resulting in frustrating arguments with various doctors who assumed I was either stupid or uninformed. Admittedly, I can't talk as well as I write and to them, especially when wearing a hospital gown, I looked like a typical old lady in her mid-70s who wasn't accustomed to researching scientific issues, so I tried not to take this patronizing attitude personally. It's infuriating, however, to deal with a system in which the average physician is not even aware of any position but the one adopted as "standard" -- either is afraid of being sued for not adhering to it, or hasn't had time to investigate the few published challenges by qualified medical professionals that do exist.

A lot is being published nowadays about the influence of the pharmaceutical industry -- or Big Pharma, as it's often called -- and the fact that it promotes drugs that aren't safe, let alone needed, as well as creating a perception of "diseases" that aren't really illnesses at all. Most people, and in fact most doctors, have fallen for these tactics so completely that the wonders of modern medication have not been doubted until recently, and still aren't doubted by the majority. The general public remains under the impression that the scandals that have arisen with respect to specific drugs such as Celebrex and Vioxx are rare exceptions. Alas, this is not the case, and even drugs that haven't been proven harmful have adverse effects on patients who take them unnecessarily. A few years back we learned that hormone replacement therapy -- for decades recommended routinely to older women -- was in fact detrimental to health. Mark my words, the same thing is going to happen with statin drugs sooner or later. It is unwise, to say the least, to urge the entire population to take drugs whose long-term effects haven't been tested simply to combat the alleged risk factors they're intended to reduce. Some dangerous drugs are necessary to treat conditions that are worse. A mere "risk factor" does not justify such medication. But the pharmaceutical industry makes money only on drugs taken by large numbers of people; need I say more?

I haven't included overtreatment in psychiatry on this page, as it's covered on a page of its own. And information about the mind's influence on health -- once widely considered heresy though it's now accepted by researchers, if not by most conventional doctors -- also has its own page. With these ruled out, along with alternative medicine, there is not a lot of heresy left, apart from criticism of the medical establishment in general. There should be more. (And in fact, since the above was written, a great deal more has appeared.)

Links to articles about medical overtreatment

Alan Cassels, M.D.
Alan Cassels, M.D.

Gibert Welch
Gilbert Welch, M.D.

Ray Moynihan
Ray Moynihan

Rosemary Gibson
Rosemary Gibson

Otis Brawley, M.D.
Otis Brawley, M.D.

Atul Gawande, M.D.
Atul Gawande, M.D.

Shannon Brownlee, M.D.
Shannon Brownlee

Nortin Hadler, M.D.
Nortin Hadler, M.D.

Uffe Ravnskov. M.D.
Uffe Ravnskov, M.D.

Less Is More Medicine. Site of Dr. Jessica Otte, a Canadian family physician, containing many articles and detailed information about the new movement toward elimination of unnecessary medical care. "In medicine, more is not always better. . . . If we avoid testing and treating when it is not needed, we can focus on doing more of the things that really matter."

Personal site of Dr. Alan Cassels, a drug policy researcher affiliated with the School of Health Information Sciences at the University of Victoria and author of books on medical overuse. Many articles and audiofiles to download, plus links to relevant material.

Risky Medicine . Aeon, December 9, 2014. By Jeff Wheelwright. "Misunderstanding risk factors has led to massive overtreatment of diseases people don’t have and probably never will."

Overkill, The New Yorker, May 11, 2015. By Atul Gawande. "Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another."

Overtreatment in the United States, PLOS One, Septermber 6, 2017. By Heather Lyu, Tim Xu, et al. "Most physicians surveyed (64.7%) believe that at least 15–30% of medical care is unnecessary. . . . Physicians perceive fear of malpractice, patient demands, and difficulty accessing prior medical records as the most common reasons for overtreatment."

How to Stop the Overconsumption of Health Care. Harvard Business Review, December 11, 2014. By Eve A. Kerr, M.D. and John Z. Ayanian. "All too often [health care choices] are driven by habit, hunches, or misaligned economic incentives, leading to substantial overuse of unnecessary, even harmful, services."

Doing More for Patients Often Does No Good. New York Times, January12, 2015. By Aaron E. Carroll. "More is expensive. More sometimes does no good. Sometimes, more is even harmful. When our policies and care ignore these facts, we all suffer."

If Patients Only Knew How Often Treatments Could Harm Them. New York Times, March 2, 2015. By Austin Frakt. "Most patients overestimate the benefits of medical treatments, and underestimate the harms."

Too Much intervention Makes Patients Sicker. The Guardian, July 19, 2014. By Aseem Malhotra, M.D. "A culture of over-investigation and over-treatment is now one of the greatest threats to western health."

Medical Errors: We Can’t Trust Doctors to Get It Right. KevinMD.com, December 12, 2014. By Allen Frances, M.D. "In any common-sense world doctors would care about risks and harms and wouldn’t always be rushing to order stupid and dangerous tests and treatments."

Unnecessary Tests and Procedures In the Health Care System. ABIM Foundation, May 1, 2014. What physicians say about the problem, the cause, and the solutions -- results from a national survey of physicians.

Finding More Cancer Isn't the Answer. Washington Post, April 10, 2007. By Dr. H. Gilbert Welch, author of Should I Be Tested for Cancer? "Cancer epidemiologists have a name for the detection of cancer in people who would otherwise never develop symptoms (or die) from the cancer. They call it over-diagnosis....The problem with over-diagnosis is that it leads to over-treatment.... All our cancer treatments have harms."

The Fight against Disease Mongering: Generating Knowledge for Action. PLOS Medicine, April 11, 2006. By Ray Moynihan, author of Selling Sickness. "Disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.... Drug companies are by no means the only players in this drama. Through the work of investigative journalists, we have learned how informal alliances of pharmaceutical corporations, public relations companies, doctors' groups, and patient advocates promote these ideas to the public and policymakers."

The Cost Conundrum. New Yorker, June 1, 2009. By Atul Gawande. "Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse."

Overtested, Overmedicated, and Overtreated, AARP Bulletin, April 8, 2010. By Tom Lombardo. Interview with Rosemary Gibson, coauthor of The Treatment Trap. "The spiral of overuse . . . is an epidemic and is likely to continue.

How We Do Harm, a chapter from the book of that name by Dr. Otis Brawley, chief medical officer at the American Cancer Society. "I can't think of a single anecdote of doctors creating or encouraging situations where a patient who is ready to die is instead subjected to aggressive care. . . . It's so wrong that you can't possibly justify it. Yet patients demand this kind of care, and we oblige."

The Perils of Prevention. New York Times, March 16. 2003. "A troubling trend has taken root when it comes to doctors actively treating patients with drugs or procedures to prevent disease.... It is the general faith in the power of medical intervention to thwart not only certain discrete diseases, like hypertension, but also most chronic or potentially life-threatening conditions."

Overdiagnosis: Bad for You, Good for Business, BU Today, October 26, 2011. By Lisa Chedeket. "The biggest problem is that overdiagnosis triggers overtreatment, and all of our treatments carry some harm," says [Gildert] Welch."

Too Much Cardiac Testing, New York Times, March 16, 2015. By Nicholas Bakalar. "Routine cardiac testing of adults without symptoms has not been shown to improve patient outcomes, and can lead to potential harms."

Less is More: Not “Going the Distance” and Why, Journal of the National Cancer Institute, November 9, 2011. By Russell Harris and Linda S. Kinsinger. "For most of the population, going the distance [in screening for colorectal cancer] may well provide small benefits with larger costs and harms."

Learning to Say No to Dialysis, New York Times, March 27, 2015. By Lisa Span. "In a Canadian survey, 61 percent of patients said they regretted starting dialysis, a decision they attributed to physicians’ and families’ wishes more than their own."

Too Much Medicine; Too Little Care. British Medical Journal, July 2, 2013. (Requires registration.) "We are now so busy managing the proliferation of risk factors, 'incidentalomas,' and the worried well that we lack the time to care properly for those who are seriously ill."

Right Care Alliance. A declaration signed by many doctors and other health care professionals. "Performing unnecessary medical tests and treatments is unethical and unacceptable. . . . Overuse exposes patients to harm, including the risk of serious injury or death, suffering, and financial ruin, with little or no possibility of benefit."

On the Medicalization of Our Culture. Harvard Magazine, April 23, 2009. A report on a symposium held by scholars of history, law, anthropology, neuroscience, and literature.

Selling Sickness, a 2013 conference focusing on disease-mongering and the urgent need for active healthcare reform efforts. The presentations can be downloaded.

Avoiding Avoidable Care, a 2012 conference organized by the Lown Institute to discuss the scope of avoidable care, its causes and consequences, and its implications for medical professionalism. The presentations can be read online.

Choosing Wisely. An initiative of the ABIM Foundation aiming to promote conversations between providers and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.

Center for Medical Consumers, containing many articles to help patients decide what treatment is, or is not, necessary. "Overtreatment, that is, the unnecessary use of tests, drugs, and surgical procedures, is the hallmark of America’s medical care system."

International Network of Cholesterol Skeptics, a growing group of scientists, physicians, other academicians and science writers from various countries who contest the theory that cholesterol is responsible for heart disease. "For decades, enormous human and financial resources have been wasted on the cholesterol campaign, more promising research areas have been neglected, producers and manufacturers of animal food all over the world have suffered economically, and millions of healthy people have been frightened and badgered into eating a tedious and flavorless diet or into taking potentially dangerous drugs for the rest of their lives. As the scientific evidence in support of the cholesterol campaign is non-existent, we consider it important to stop it as soon as possible."

The Benefits of High Cholesterol. Excerpt from The Cholesterol Myths by Dr. Uffe Ravnskov, a respected Danish researcher who has published extensively in medical journals. "High cholesterol is associated with longevity in old people. It is difficult to explain away the fact that during the period of life in which most cardiovascular disease occurs and from which most people die ... high cholesterol occurs most often in people with the lowest mortality....To the public and the scientific community I say, 'Wake up!'"

The Obesity Myth, an excerpt from the book by attorney Paul Campos. "The current barrage of claims about the supposedly devastating medical and economic consequences of ‘excess’ weight is a product of greed, junk science, and outright bigotry. It is a witch-hunt masquerading as a public health initiative."

Medical Nemesis, an excerpt from the classic book by Ivan Illich on the medicalization of society.

Books critical of today's standard medical practice

All of these are by doctors, scientific researchers, or investigative journalists; I have excluded books by practitioners of alternative medicine, which often make valid criticisms of conventional medicine but which promote forms of health care that are in themselves questionable and therefore confuse the issue.

How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, Otis Webb Brawley, St. Martin's, 2012, 0312672977.

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee, Bloomsbury, 2007, 1582345805.

False Hopes: Overcoming the Obstacles to a Sustainable, Affordable Medicine, Daniel Callahan, Rutgers University Press, 1999, 0813526744.

Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System, Daniel Callahan, Princeton University Press, 2009, 069114236X.

What Kind of Life: The Limits of Medical Progress, Daniel Callahan, Touchstone Books 1991, 0671732900.

The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health, Paul Campos, Gotham Books, 2004, 1592400663.

Seeking Sickness: Medical Screening and the Misguided Hunt for Disease, Alan Cassels, Greystone Books, 2012, 9781771000321.

The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders, Peter Conrad, Johns Hopkins University Press, 2007, 080188585X.

The Cholesterol Delusion, Ernest N. Curtis, M.D., Dog Ear Publishing, 2010, 9781608449620.

Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, Richard A. Deyo, M.D., & D. L. Patrick, AMACOM, 2005, 0814408451.

Tyranny of Health: Doctors and the Regulation of Lifestyle, M. Fitzpatrick, Routledge, 2001, 0415235723.

Being Mortal: Medicine and What Matters in the End, Atul Gawande, Henry Holt, 2014, 9780805095159.

The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent It, Rosemary Gibson and Janardan Singh, Ivan R. Dee, 2010, 1566638429.

The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies, Muriel R. Gillick M.D., Harvard University Press, 2006, 9780674021488.

Lipitor: Thief of Memory, Duane Graveline, M.D., Duane Graveline, 2006, 1424301629.

The Citizen Patient: Reforming Health Care for the Sake of the Patient, Not the System, Nortin M. Hadler, M.D., University of North Carolina Press, 2013, 9781469607047.

Last Well Person: How to Stay Well Despite the Health-care System, Nortin M. Hadler, M.D., McGill-Queen's University Press, 2004, 0773527958.

Rethinking Aging: Growing Old and Living Well in an Overtreated Society, Norton M. Hadler, M.D., University of North Carolina Press, 2011, 0807835064,

Worried Sick: A Prescription for Health in an Overtreated America, Nortin M. Hadler, M.D., University of North Carolina Press, 2008, 0807831875.

Limits to Medicine: Medical Nemesis, The Expropriation of Health, Ivan Illich, Marion Boyars, 1999 (1976), 0714529931.

The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It, Malcolm Kendrick, M.D., John Blake, 2007, 1844543609.

Curing Medicare: One doctor's View of How Our Health Care System Is Failing the Elderly and How to Fix It, Andy Lazris, M.D., CreateSpace, 2014, 1499549806.

What Your Doctor Won't or Can't Tell You: The Failures of American Medicine -- and How to Avoid Becoming a Statistic, Evan Levine, M.D., Berkley, 2005, 0425200086.

The Patient Paradox: Why Sexed-up Medicine Is Bad for Your Health, Margaret McCartney, Pinter & Martin, 2012, 9781780660004.

The Heart Revolution: The Extraordinary Discovery That Finally Laid the Cholesterol Myth to Rest, Kilmer S. McCully, M.D., Harper Paperbacks, 2000, 0060929731.

What Doctors Don't Tell You: The Truth About The Dangers Of Modern Medicine, Lynne McTaggart, Avon, 1998, 0380807610.

Confessions of a Medical Heretic, Robert S. Mendelsohn, M.D., McGraw Hill, 1990 (1980), 0809241315.

Lifespan: New Perspectives on Extending Human Longevity, Thomas J. Moore, Touchstone Books, 1994, 0671886223.

Heart Failure: A Critical Inquiry into American Medicine and the Revolution in Heart Care, Thomas J. Moore, Touchstone Books, 1990, 0671724444.

Questioning Chemotherapy, Ralph W. Moss, Equinox Press, 1995, 188102525X.

The Cancer Industry: The Classic Exposé on the Cancer Establishment, Ralph W. Moss, Equinox Press, 1996, 1881025098.

Fat Politics: The Real Story Behind America's Obesity Epidemic, J. Eric Oliver, Oxford University Press, 2006, 0195169360.

Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick, Lynn Payer, Wiley 1994, 0471007374.

Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France, Lynn Payer, Penguin, 1989, 0140124047.

Diseasing of America: How We Allowed Recovery Zealots and the Treatment Industry to Convince Us We Are Out of Control, Stanton Peele, Lexington Books, 1995, 0028740149.

The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease, Uffe Ravnskov, M.D., NewTrends Publishing, 2000, 0967089700.

The Secrets of Medical Decision Making: How to Avoid Becoming a Victim of the Health Care Machine, Oleg I. Resnik, M.D., Loving Healing Press, 2005, 1932690174.

Medical Care Can Be Dangerous to Your Health: A Guide to the Risks and Benefits, Eugene D. Robin, M.D., Harper & Row, 1986, 0060970294. (Hardcover edition, 1984, is titled Matters of Life and Death: Risks and Benefits of Modern Medicine.)

A Bitter Pill: How the Medical System Is Failing the Elderly, John Sloan, Greystone Books, 2009, 1553654552.

For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health, Jacob Sullum, Touchstone, 1999, 0684871157.

The Theology of Medicine: The Political-Philosophical Foundation of Medical Ethics, Thomas Szasz, Syracuse University Press, 1988, 0815602251.

Pharmacracy: Medicine and Politics in America, Thomas Szasz, Praeger, 2001, 0275971961.

The Medicalization of Everyday Life: Selected Essays, Thomas Szasz, Syracuse University Press, 2007, 0815608675.

Less Medicine, More Health: 7 Assumptions that Drive Too Much Medical Care, H. Gilbert Welch, M.D., Beacon Press, 2015, 9780807071649.

Overdiagnosed: Making People Sick in the Pursuit of Health, H. Gilbert Welch, M.D., Beacon Press, 2012, 0807022004.

Should I Be Tested for Cancer?: Maybe Not and Here's Why, H. Gilbert Welch, M.D., University of California Press, 2004, 0520248368.

When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests, Leana Wen, M.D. and Joshua Kosowsky, M.D.. St. Martin's Griffin, 2014, 1250048486.

Is Heart Surgery Necessary?: What Your Doctor Won't Tell You, Julian Whitaker, M.D., Regnery, 1998, 0895264730.

Books dealing mainly with the pharmaceutical industry

Overdosed America: The Broken Promise of American Medicine, John Abramson, M.D., Harper Perennial, 2005, 0060568534.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It, Marcia Angell, M.D., Random House, 2005, 0375760946.

Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, Jerry Avorn, M.D., Knopf, 2004, 0375414835.

Inventing Disease and Pushing Pills: Pharmaceutical Companies and the Medicalisation of Normal Life, Jorg Blech, Routledge, 2006, 0415390710.

Before You Take that Pill: Why the Drug Industry May Be Bad for Your Health , J. Douglas Bremner, M.D. Avery, 2008, 583332952.

Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, Howard Brody, Rowman & Littlefield, 2007, 0742552195.

Overdose: The Case Against the Drug Companies, Jay S. Cohen, M.D., Tarcher/Penguin, 2004, 158542370X.

Generation Rx: How Prescription Drugs Are Altering American Lives, Minds, and Bodies, Greg Critser, Houghton Mifflin, 2005, 0618393137.

Drugs for Life: How Pharmaceutical Companies Define Our Health, Joseph Dumit, Duke University Press, 2012, 0822348713.

Pharmageddon, David Healy, University of California Press, 2012, 0520270983.

On The Take: How Medicine's Complicity with Big Business Can Endanger Your Health, Jerome P. Kassirer, M.D., Oxford University Press, 2005, 0195176847.

Big Pharma: Exposing the Global Healthcare Agenda, Jacky Law, Carroll & Graf, 2006, 0786717831.

Prescription for Disaster: The Hidden Dangers in Your Medicine Cabinet, Thomas J. Moore, Dell 1999, i0440234840.

Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients, Ray Moynihan and Alan Cassels, Nation Books, 2006, 156025856X.

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, Melody Petersen, Farrar, Straus and Giroux, 2008, 0374228272.

Last updated in December, 2014