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By using our website and our services, you agree to our use of cookies as described in our Cookie Policy. An integral part of the early-'80s thrash metal movement that spawned acts like Metallica and Anthrax , New Jersey's Overkill garnered a reputation for brutal, pounding speed and technique.

Emerging in with the punishing Feel the Fire, the band built up a strong following in the metal underground with subsequent outings like Under the Influence and Years of Decay Despite enduring myriad label and lineup changes -- bassist D. Verni and lead vocalist Bobby "Blitz" Ellsworth have been the group's sole constant members -- Overkill have remained one of the East Coast's most successful and versatile metal outfits, dabbling in doom, industrial, and stoner metal, while releasing an abundance of critically acclaimed albums like Ironbound , White Devil Armory , and The Wings of War Verni bass.

An early demo, Power in Black, made waves in the underground tape-trading circuit, which was starting to catch fire as West Coast thrash artists like Testament and Exodus began gaining some traction. The demo caught the attention of Megaforce Records , which issued the band's full-length studio debut, Feel the Fire, in High-profile shows alongside luminaries like Slayer and Anthrax followed, and with the American thrash scene in full tilt, Overkill inked a major-label deal with Atlantic , which put out their sophomore effort, 's uncompromising Taking Over.

Falck made his studio debut on 's Under the Influence, which marked the group's highest-charting LP to date. Continuing their breakneck pace, the band issued the Terry Date -produced Years of Decay the following year, which saw them pushing their sound in a more epic direction, while maintaining the neck-snapping attack of their debut. A dispute over royalties and the group's general direction led to the departure of Gustafson in , making way for two new guitarists, Rob Cannavino and Merritt Gant, the latter of whom previously served as Gustafson's guitar tech. The newly minted quintet issued their fifth studio long-player, the brooding and relentlessly heavy Horrorscope, the following year, which introduced elements of doom into the mix and would go on to become a defining release and fan favorite.

Overkill continued to move toward a more Sabbath y stoner rock style on 's I Hear Black, which saw M. The album was divisive, with some fans bemoaning the group's new direction, but it also arrived in the midst of a huge shakeup in the mainstream, with grunge putting heavy metal on the backburner.

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More than happy to leave the major label, which had long since turned its attention elsewhere, the group signed with CMC International , an independent destination that served as a safe haven for hard rock and heavy metal groups during the alternative rock and grunge boom of the '90s. More than a decade ago, I saw a young woman in the emergency room who had severe pelvic pain. A standard X-ray showed nothing.

I examined her and found signs of pelvic inflammatory disease, which is most often caused by sexually transmitted diseases.

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If I had, I might have ordered a pelvic CT scan or even recommended exploratory surgery to investigate further. It is different, however, when I think about my experience as a patient or a family member. I can readily recall a disturbing number of instances of unnecessary care.

I began asking people if they or their family had been subject to what they thought was unnecessary testing or treatment. Almost everyone had a story to tell. Some were appalling. My friend Bruce told me what happened when his eighty-two-year-old father developed fainting episodes. His doctors did a carotid ultrasound and a cardiac catheterization. The tests showed severe atherosclerotic blockages in three coronary arteries and both carotid arteries. He had smoked two packs of cigarettes a day since the age of seventeen, and in his retirement years was paying the price, with chronic lung disease, an aortic-aneurysm repair at sixty-five, a pacemaker at seventy-four, and kidney failure at seventy-nine, requiring dialysis three days a week.

The doctors recommended doing a three-vessel cardiac-bypass operation as soon as possible, followed, a week or two later, by surgery to open up one of his carotid arteries. The father deferred the decision-making to the son, who researched hospitals and found a team with a great reputation and lots of experience. The team told him that the combined procedures posed clear risks to his father—for instance, his chance of a stroke would be around fifteen per cent—but that the procedures had become very routine, and the doctors were confident that they were far more likely to be successful than not.

The operation would not make him feel better. How long would it take for the future benefit to outweigh the immediate risk of surgery? Therefore, it would take fifteen years before the benefit of the operation would exceed the fifteen-per-cent risk of the operation. And he had a life expectancy far shorter than that—very likely just two or three years. The potential benefits of the procedures were dwarfed by their risks.

But he had at least survived. His dad had to move into a nursing home. Nine months later, his father died. That is what low-value health care can be like. So they try to sell you on a lot of stuff. Second level, they do some real damage mucking around.


Overkill (band)

Even reputable professionals with the best intentions tend toward overkill, he said. To illustrate the point, he, too, had a medical story to tell. He was referred to an orthopedic surgeon to discuss whether to do physical therapy or surgery. Very unassuming. I had no reason not to trust the guy. Sure enough, the surgeon recommended arthroscopic knee surgery. Ray went for a second opinion, to a physical therapist, who, of course, favored physical therapy, just as the surgeon favored surgery.

Ray chose physical therapy.

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Maybe I will end up having to go back. But he believed.

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What Ray recommended to his car-owning listeners was the approach that he adopted as a patient—caveat emptor. He did his research. He made informed choices. He tried to be a virtuous patient. The virtuous patient is up against long odds, however. One major problem is what economists call information asymmetry. In , Kenneth Arrow, who went on to win the Nobel Prize in Economics, demonstrated the severe disadvantages that buyers have when they know less about a good than the seller does. His prime example was health care. Doctors generally know more about the value of a given medical treatment than patients, who have little ability to determine the quality of the advice they are getting.

Doctors, therefore, are in a powerful position. It has been hard for patients and doctors to recognize that tests and scans can be harmful. Why not take a look and see if anything is abnormal? People are discovering why not. The United States is a country of three hundred million people who annually undergo around fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests.

Often, these are fishing expeditions, and since no one is perfectly normal you tend to find a lot of fish. Excessive testing is a problem for a number of reasons. These direct risks are often greater than we account for. If you have crushing chest pain and shortness of breath, you start with a high likelihood of having a serious heart condition, and an electrocardiogram has significant value.

Experts recommend against doing electrocardiograms on healthy people, but millions are done each year, anyway. Resolving the uncertainty of non-normal results can lead to procedures that have costs of their own. You get an EKG. The heart tracing is not completely normal, and a follow-up procedure is recommended. Overtesting has also created a new, unanticipated problem: overdiagnosis. This is the correct diagnosis of a disease that is never going to bother you in your lifetime.

For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. Yet only a tiny reduction in death, if any, has resulted.

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My last patient in clinic that day, Mrs. A surgeon removed it, and a biopsy was done.

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The lump was benign. So when the surgeon told Mrs. More than a third of the population turns out to have these tiny cancers in their thyroid, but fewer than one in a hundred thousand people die from thyroid cancer a year. Only the rare microcarcinoma develops the capacity to behave like a dangerous, invasive cancer.

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When the imaging revealed another five-millimetre nodule, he recommended removing the rest of her thyroid, out of an abundance of caution. The patient was seeing me only because the surgeon had to cancel her operation, owing to his own medical issues.

The surgery posed a greater risk of causing harm than any microcarcinoma we might find, I explained. There was a risk of vocal-cord paralysis and life-threatening bleeding. Removing the thyroid would require that she take a daily hormone-replacement pill for the rest of her life.

We were better off just checking her nodules in a year and acting only if there was significant enlargement. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. In South Korea, widespread ultrasound screening has led to a fifteen-fold increase in detection of small thyroid cancers. Thyroid cancer is now the No. Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.

Every cancer has a different ratio of rabbits, turtles, and birds, which makes the story enormously complicated.