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Is Preventive Medicine Really Overtreatment?

Is Preventive Medicine Really Overtreatment?

From the NPR Health News item

In Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch argues that modern medicine is looking too closely for disease, and that unnecessary screenings, MRIs and CT scans turn healthy people into diseased patients, by revealing often harmless abnormalities….

….

But overtreatment isn’t just a problem for patients diagnosed with cancer. It could sometimes be a problem for healthy people, as my next guest writes in his book “Overdiagnosed: Making People Sick in the Pursuit of Health,” because even healthy people are subject to more and more tests every time they visit the doctor.

Think about it, what do you do? You get the normal tests. You get your cholesterol level, maybe your liver test if you’re doing statins, you have a PSA, you have a body scan, tests that are often they often result in treatment. And because the traditional dogma is, as my next guest writes, more early diagnosis means better medical care, which means more treatment; and more treatment means better health.

But is that traditional view true? Is it accurate? Should we still be thinking about it that way? Are all these tests and treatments actually improving our health or are we looking too hard for disease?….

FLATOW: Why is it because doctors can do all these diagnoses, all these tests that they do, do them?

Dr. WELCH: Well, certainly, part of it is what’s possible, and what’s possible is, of course, changed dramatically over the last year. But it’s also part of our ethos, if you will, that it’s always a good thing to look for early forms of disease. And, of course, that message just been sent out to the public through the media and other sources that, of course, the thing you want to do is look for early forms of disease.

But the truth is there are really two sides to the story. I think patients are used to thinking of treatments as having side effects, but so does testing. And the side effect of looking for early forms of disease is that we find, virtually, all of us have some. That’s because we all harbor some abnormalities. And we never know which patients are those that have abnormalities that are going to cause problems in the future. So we tend to treat everybody we find with an abnormality and that means we’re just treating some patients who can’t benefit from our treatment because they were never going to develop the problem at hand if they’re overdiagnosed.

FLATOW: But how do you say to the person, you know, that maybe in the minority, as you say, that you may have saved that person’s life by overdiagnosing them? Is that worth of maybe one in a hundred cases?

Dr. WELCH: Well, I think that’s the question we all need to face. And, you know, sort of, traditionally, doctors have focused on the one out of a thousand we might help by looking for early forms of disease. But we haven’t really asked the question, what happens to the other 999? And this problem was really demonstrated to us in prostate cancer screening, which is really a poster child for the problem of overdiagnosis.

20 years ago, a simple blood test was introduced. And 20 years later, over one million Americans have been treated for a cancer that was never going to bother them. That test was the PSA, or prostate specific antigen. And it turned out an awful lot of men had abnormal PSAs. Many were found to have microscopic cancers far more than whatever suffer from prostate cancer.

Now, you might say, does it matter? Yeah, sure it matters because most of these men were treated with either radical surgery or radiation. And roughly a third suffered side effects of treatment generally related to bowel, bladder or sexual function. Even a few have died from it.

So this is a problem. It’s a matter of finding the balance between the question of just how hard we should be looking for problems in well patients……

February 13, 2011 Posted by | Health News Items | , , , , , , , , | Leave a comment

   

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