"The Disease Prevention Illusion: A Tragedy in Five Parts" (just a general piece)
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Most of the arguments against screening closely parallel the arguments against testing ME patients to see what the hell is really going on.
1) People are just trying to over-medicalize their lives. (ME patients are just medicalizing their emotional problems.)
2) An early diagnosis isn't helpful. (Diagnosis with "ME" is harmful because it makes us think we're sick.)
3) Routine screening in the absence of symptoms isn't helpful, especially when screening tests are inaccurate and there's no treatment. (Don't run any tests on ME patients, because there's no cure for it, except CBT which will be used regardless of abnormal lab results.)
4) Evidence (-based Medicine?) opposes much of the use of screening. (There aren't a majority of ME patients with the same abnormal results in any research trials, therefore it is not worthwhile to look for anything abnormal.)
5) People who aren't sick are hogging medical resources by insisting on being screened, which is harming the people who are actually sick. (ME patients are costing too much money/using too many resources by insisting on going to the doctor for their psychosomatic symptoms.)
This piece seems to be one big argument in favor of withholding medical resources. Some of the statements seem reasonable enough, but they make me very uncomfortable when compared to the arguments used to advocate withholding medical treatment for people who do have unverified symptoms.
I also find it odd that one of the main examples used is breast cancer ... and it's well-known that catching cancer early is extremely important, yet there's still the insistence that early diagnosis is not helpful.
I agree with the rest of your post, and I can tell you where they are getting this, but I don't know how helpful the information actually is.
With the technology we have now, doctors are not sure about some of the breast cancers we are able to find, thus treating, whether all of then require treatment. Some might grow very slowly.
http://www.nhs.uk/news/2012/10October/Pages/Does-breast-cancer-screening-do-more-harm-than-good.aspx
one literature review found:
How they know which is which, I don't know. Some breast cancers grow slowly.
Most people have cancer about 100 times during their lives without knowing it, and their immune system can manage it, but I don't know if that would always be visible on imaging.
I am not sure how they know for sure what's overdiagnosis from a literature review, when the doc did not seem to know at the time of treatment. That seems a bit sketchy to me.
If they were that sure, doctors would be able to tell the patient, it's probably safe to watch and wait, but it's your risk so it's up to you (some patients would indeed decide not to treat, and some would want to treat anyway, just depends on which risk looked worse to them).
If they are not that sure, they should probably not be telling everyone x definite amount is overdiagnosis.
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but there are risks to some kinds of screening, which might itself cause cancer or other problems.
Other problems of screening are that
1) the doctor might think screening is the main job and once that is done, the main work of deciding whether the patient is healthy or ill and what the patient might have is also done.
2) screening, especially when done by questionnaire, may be inaccurate and if it doesn't lead to a referral for verification and follow-up, might do more harm than good (e.g. mental health)
3) screening doesn't always measure what was planned to be measured (depression example again)
4) screening can impose rationing instead of access (Coyne, again with depression, but the guy is good). This can definitely apply to ME when we might need to see an immunologist, for example, but the GP/PCP doesn't know what test to run to prove to specialist that we need to be there (specialtists don't take just anyone who thinks they want that specialty, typically)
Other problems of screening are that
1) the doctor might think screening is the main job and once that is done, the main work of deciding whether the patient is healthy or ill and what the patient might have is also done.
2) screening, especially when done by questionnaire, may be inaccurate and if it doesn't lead to a referral for verification and follow-up, might do more harm than good (e.g. mental health)
3) screening doesn't always measure what was planned to be measured (depression example again)
4) screening can impose rationing instead of access (Coyne, again with depression, but the guy is good). This can definitely apply to ME when we might need to see an immunologist, for example, but the GP/PCP doesn't know what test to run to prove to specialist that we need to be there (specialtists don't take just anyone who thinks they want that specialty, typically)
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taniaaust1
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Im finding that very weird.. 681 diagnosed and only 43 deaths prevented from it? Does that mean that nearly all of them died from it and hence diagnoses wasnt much good at all? Has breast cancer diagnoses got that low a rate of preventing death?
Snow Leopard
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My personal opinion is that surely the recent high survival rate of certain cancers (breast, prostate, cervical) these days is precisely due to early detection?
I'm having a look at the studies now.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001877.pub5/full
Edit - okay, there are some valid concerns with breast cancer screenings, particularly unexpectedly high false positive diagnoses, as well as poor differentiation between malignant and non-malignant cancers, leading to more treatment than otherwise necessary.
Routine testing for women <50-55 years of age is probably not worthwhile.
I think the key is not to abandon the idea of screening but to develop higher quality methods with much lower false positive rates and less invasive/painful technologies.
I'm having a look at the studies now.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001877.pub5/full
Edit - okay, there are some valid concerns with breast cancer screenings, particularly unexpectedly high false positive diagnoses, as well as poor differentiation between malignant and non-malignant cancers, leading to more treatment than otherwise necessary.
Routine testing for women <50-55 years of age is probably not worthwhile.
I think the key is not to abandon the idea of screening but to develop higher quality methods with much lower false positive rates and less invasive/painful technologies.
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One example regarding screening in ME is testing for thyroid cancer. I know one person who had the test because of what one specialist had said. Lumps were found and she had various follow-up tests. She found it all very stressful. Also, having surgery in and around your thyroid risks damage to your voice. Thyroid Cancer is very slow growing so there's a question there whether the benefits of screening for thyroid outweighs the risk, just as there are questions re: screening for Breast Cancer in general or in particular age groups.
Esther12
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I'm really sympathetic to concerns about over medicalization, and the way in which the systems and incentives around medicine and medical research seem to push people towards exaggerated claims about the benefits of their interventions. I don't know enough about the specifics mentioned in that article to make a judgement, but it would not surprise me if much of what was claimed was right.
We have a bowel cancer screening programme in Scotland for the over 50s. You get sent out cards and sticks biannually, and you have to smear poo samples from 3 different days in little windows and send it back.
A friend of mine has had his bowel cancer detected really early and has had his treatment.
A friend of mine has had his bowel cancer detected really early and has had his treatment.
I realise that - I have read a few papers on the subject of breast cancer screening that say the overdiagnosis is the big problem - leading some women to have unneccessary surgery and worry.
But I personally don't appreciate my own chances of having something serious detected, reduced by the financial constraints of applied statistics.
But I personally don't appreciate my own chances of having something serious detected, reduced by the financial constraints of applied statistics.
My problem with that is that the determination of what is "beneficial" often takes financial cost into consideration to a large part. And I have trouble believing that screening causes more medical harm than it prevents. Hence the entire subject feels like an attempt to put a value on human lives and well-being, whereas I see preventing even a few early deaths as being highly beneficial, even if thousands receive no such benefit and a few are inconvenienced by false-positives.
That said, I see the other side too. It just creeps me out too much on an emotional level due to the similarities to the BPS approach.
Esther12
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If no concern about cost is placed upon medical care, then we will end up devoting almost all our resources to medical care. I don't know about you, but I'm not sure that medicine is that great a use of money - a lot of it seems rather rubbish. That concern about costs is the primary limiting factor on the expansion of medicine does lead to it's own problems, with those who decide how funds are allocated seemingly too excited by cheap interventions that have little real evidence for efficacy, but broadly my impression is that societies spend too much on medical care, not enough on promoting social justice, and not nearly enough on sceptical evaluations on the evidence to ensure that the medical care being provided is really as beneficial as is claimed.
I'd rather see tons of wonga spent on medical stuff than on space exploration...
but when men get together and see a chance to carry on playing with boys' toys when they are "adults" and the ones deciding where money should be spent, they get to carry on playing.
I'm not saying loads of decent research which can be apllied in other areas hasn't happened as a result of exploring space, just that it never was anything more than boys getting to stay being boys.
The problem is that money is now a god, not the tool it should be. And some folk are seriously addicted to money. The ones who have it all and who tell our various governments what to do.
They are not going to admit to being stupid addicts - and their judgements cannot be trusted because of their addiction.
We are doomed, I tell you - doomed!
but when men get together and see a chance to carry on playing with boys' toys when they are "adults" and the ones deciding where money should be spent, they get to carry on playing.
I'm not saying loads of decent research which can be apllied in other areas hasn't happened as a result of exploring space, just that it never was anything more than boys getting to stay being boys.
The problem is that money is now a god, not the tool it should be. And some folk are seriously addicted to money. The ones who have it all and who tell our various governments what to do.
They are not going to admit to being stupid addicts - and their judgements cannot be trusted because of their addiction.
We are doomed, I tell you - doomed!
Snow Leopard
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Screening could be done with less harm and less cost.
Since mammography is generally accepted in western countries, there seems to be less emphasis on improving methods to reduce false diagnoses or reduce harm. I mean there are modern alternatives to squashing ones breasts in metal plates, blasting them with x-rays and taking a picture using old-fashioned film. I wonder if the decision makers (who don't believe the process needs to be improved) are all men?
Since mammography is generally accepted in western countries, there seems to be less emphasis on improving methods to reduce false diagnoses or reduce harm. I mean there are modern alternatives to squashing ones breasts in metal plates, blasting them with x-rays and taking a picture using old-fashioned film. I wonder if the decision makers (who don't believe the process needs to be improved) are all men?
best as I can tell, mammogram is probably not necessary in younger women with no risk factors (maybe genetic test would be better?), but informal self-exam/ partner exam is still important by all accounts.
And yes, improving the screening in all the ways you mentioned.
haha, probably.
Waverunner
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Cell free DNA or so called liquid biopsies will pave the way for very effective cancer screening programs. What we shouldn't forget is, that many cancers need to reach a specific size, before they can be detected with current screening methods. And even if they are detected, we know nothing about their genetic make up or how targeted therapy should look like. In the future, we will screen for cancer in the blood and we will know more about the genetic profile of tumors, than anytime before.