How Perfectly Healthy People Are Turned into Patients
Medical screening over-promises and under-delivers—dragging people with no health problems into the medical system.
Healthy People Turned into Patients
by Alan Cassels, Evidence Network
What could possibly be wrong with having a mammogram? Or a PSA test for prostate cancer? Even a full body CT scan? Finding the signs of illness before it strikes you down is always the best course of action – isn’t it?
You might have similar thoughts when offered a routine screening test, ultimately believing that screening for illness before it happens can only do good. So, you may be in for a shock, as I was, when I discovered how often medical screening has overpromised and under-delivered, And how frequently the “screen early, screen often” paradigm – including even simple blood tests to check for high cholesterol – can rapidly turn perfectly healthy people into patients. Unnecessary care can be bad for your health.
Some medical screening, such as early testing for colon or cervical cancer, has a long lineage of strong evidence that it can save lives. Others, not so much.
The poster child for inappropriate and harmful screening is probably the full body CT scan, which is routinely promoted with a ‘better safe than sorry’ message that is compelling, but is not supported by either independent experts or good science.
Here’s what not advertised: a full-body scan is pretty much guaranteed to find some kind of abnormality that likely won’t hurt you.
In a study published in Radiology, 86 per cent of patients of 1,000 symptom-free people who underwent full body CT scans had an abnormality detected. The average person had 2.8 abnormalities revealed by the CT scan – items which appeared unusual, but either disappeared on their own or were so slow-growing that they never went on to threaten the individual.
Even for screening programs that are well-studied, such as those for breast or prostate cancers, the chances of being saved by the test are often outweighed by the possibility that the individual will be hurt by the testing or possible treatments which follow.
Yet, since most of us know someone whose life has been ‘saved’ by a test, we submit.
The PSA test, which screens a man’s blood looking for risks of prostate cancer, might seem like a no brainer for many men, especially those who have lost brothers or a father to the disease. But what most of us aren’t going to hear is that when an individual has a high PSA score (which could be caused by many things), the doctor can’t tell if the patient has the slow growing-type of prostate cancer that the majority of men eventually get (and won’t die from), or the fast-growing type that can be quickly lethal.
Here’s the data, taken from a study published in the New England Journal of Medicine: to save a single man dying from prostate cancer, 1,410 men need to be screened, and of those, 48 will undergo treatment (with chemotherapy, surgery or drugs). About 30 of the treated men will end up impotent or incontinent (a possible consequence of the treatment).
Screening can be a terribly difficult and emotional decision because many of us don’t think in terms of numbers like these. Medical screening falls under the spell of the “popularity paradox” where, despite high levels of false positives for many tests (common in breast, lung and prostate cancer screening especially), people still rally behind them. We ask our friends and relatives to help raise money for ‘the cure’ and are cheerleaders for the message of early detection.
In the world of breast cancer screening, many of us know a woman who has dealt successfully with the disease, and are led to believe that early screening saved a life. The truth is that some women, even with screening, will die. And many women, without screening, will be treated successfully. What’s often not factored into the decision-making process is the potential harm incurred from the many false positives, the subsequent radiation from repeated testing, and the pain and suffering from potential biopsies and treatment.
One of the most common side effects of medical screening – the wrenching psychological impact of telling someone they may have cancer when they don’t – is rarely taken into account. And it’s significant.
The latest research for breast cancer screening, from the Canadian Task Force on Preventive Health Care, says that you’d have to give mammograms to 2,100 women aged 40 to 49 every two years for 11 years to save one life. In the interim, screening will result in almost 700 false positives (think more testing, more x-rays and investigations) and about 75 women will have an unnecessary biopsy. Informed decision-making the best medicine.
Early screening on its own, without the evidence to back up its usefulness in saving or improving lives, is not only costly to our public health system, but may actually cause patient harm.
The principle here is that even when saving a life by screening seems the intuitive and right thing to do, it’s not a deal you should ever enter into without understanding the probabilities first – your chances of being helped or hurt by the test. Talk to your health provider, and always ask for the evidence.
Alan Cassels is an expert advisor with EvidenceNetwork.ca, and a researcher at the University of Victoria. His new book, Seeking Sickness: Medical Screening and the Misguided Hunt for Disease (Greystone Books) will be released this month.
Not the exact same topic, but in the ball park, and an interesting read none the less. We've been conditioned to fear everything, even our own bodies.
Quoted Text
Risk is Not Dangerous May 11, 2012By eric
Risk is fun – and risk is part of life. Otherwise, we’d never get out of bed. No, rewind some more. We’d never leave our mother’s uterus.
This idea that risk – note, not recklessness, not irresponsibility – just “risk” – is something to be stamped out at all costs is perhaps the most cancerous notion of our era, right behind egalitarianism and democracy.
Columbus accepted some risk when he set sail across the ocean sea. It would have been much safer, I suppose, to stay home. But then we’d not even know his name – much less celebrate a day in his honor. Those bold men who strapped themselves into a tiny capsule mounted on a very large Saturn V rocket and rode it all the way to the Moon took a risk, too.
Risk is rightly viewed as synonymous with challenge – which necessarily entails the possibility of failure. One does not seek it, one is aware of its possibility. But one accepts the possibility as the necessary price to be paid in order to meet the challenge. To strive, to achieve. To be competent rather than complacent. To do – as opposed to not doing. Risk is the very thing that makes human progress possible. To refuse to act – or to limit action – until and unless all risk is removed is to negate the possibility of acting. It is to embrace stasis – and even that amount to a false sense of security, since failing to act out of fear of risk can itself be lethally paralyzing. Think of the prey animal that freezes rather than bolts at the sight of a predator.
Yet risk-avoidance has become the cornerstone of the red giant phase American police state, whose lurid glare we all live under today. Every new authoritarian measure is proposed – is justified – on the basis of risk-avoidance, no matter how infinitesimal the risk. Any risk is too much risk. No price too high, no imposition too extreme. If it makes us safer. If it reduces some risk.
Recently, for example, the government issued a ukase that all new cars will have back-up cameras as standard equipment – even though the number of children (and others) run over by a backing-up car (more precisely, an incompetently backed-up car) is too small to even be described as a fraction of a fraction. During the past ten years, the government claims about 650 flattened toddlers. A tragedy for those involved, certainly. But does it constitute a national epidemic – a risk so great that it justifies forcing every single person in a nation of 310 million people who wishes to purchase a new car to also purchase a back-up camera? Do the math. What is the ratio? The percentage? Let’s call it an even 1,000 – out of 310 million. Oh, yes. I forget. If it saves even one life. That is the mantra.
And the result of allowing it to pass, unchallenged by reason, is that costs will be imposed on 310 million – most of whom face an immeasurably tiny risk of ever being backed-over by an SmooVee. But who will be throttled (and charged) in the name of avoiding this picayune risk.
Passing zones are disappearing. Too “risky.” More probably, not enough revenue was being generated when people could lawfully pass. The most grotesque assaults on our former right to travel unmolested are committed against us in the name of risk-avoidance.
Kids can’t play football – or even play outside. Too risky. I like to backpack. I wonder how long it will be before that, too, is declared too risky. I might fall. I might twist my ankle. I could pass out from dehydration. A snake might bite me on the ankle. There are no cameras in the woods, no emergency call boxes. It is all very, very risky. But not really. The majority of these risks – like the risks discussed above – can be reduced to almost nothing by prudent action and common sense. I watch where I step. I wear boots that prevent my ankles from flexing too much in the event I lose my footing. These keep me safe from ankle-biting snakes, too. I carry plenty of water – and keep a gun at my side for just-in-case. These put my risks down to the peripheral. They are still there. Yes, something could happen. But it probably won’t. And so, I am willing to assume the risk – rationally, reasonably.
It is – or ought to be – the same in other aspects of life, cars included. There is, for example, an element of risk involved in not wearing a seat belt. But the risk of being involved in an automobile accident can be greatly reduced by attentive, skilled driving. In which case, the not-wearing of a seat belt incurs virtually no risk at all. But rather than encourage rational risk reduction by prudent individual action, our red star police state pulsates with authoritarian fury at the merest suggestion of a theoretical risk – and pours forth its radiation upon us.
And the end result is not unlike living under the sway of an actual real-life red giant sun: We are forced indoors, our actions curtailed and limited. Everything we do is done under the oppressive heat and remorseless, never-flinching gaze.
I’d rather run a little rational risk now and then myself. Even if it means I occasionally get a sunburn.
IT WAS ALL A LIE....but they will 'require' the prodding and poking just like in the alien stories and their probes....
for:
1. research 2. fear control 3. $ industry 4. prove legitamacy of their existence 5. requirement to participate in the 'free' healthcare system
we should be careful what our lazy overweight, sloven a$$es wish for.....easy, controlled governement/healthcare systems will KILL US!!!!!!!!!!!!!!!!!!!!!
...you are a product of your environment, your environment is a product of your priorities, your priorities are a product of you......
The replacement of morality and conscience with law produces a deadly paradox.
STOP BEING GOOD DEMOCRATS---STOP BEING GOOD REPUBLICANS--START BEING GOOD AMERICANS
IT WAS ALL A LIE....but they will 'require' the prodding and poking just like in the alien stories and their probes....
Is it sexy aliens with big boobs?...I like those type of aliens
"Approval ratings go up and down for various reasons... An example is the high post 911 support for GWB even though he could be said to be responsible for the event." --- Box A Rox '9/11 Truther'
Melania is a bimbo... she is there to look at, not to listen to. --- Box A Rox and his 'War on Women'
Is it sexy aliens with big boobs?...I like those type of aliens
Sexy aliens with big boobs? Try the movie "Paul", now on HBO. It has 'sexy aliens' with three boobs!
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
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