The high cost and low return of preventive medical care.
H. Gilbert Welch writes in the New York Times:
Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children…
The problem with routine cancer screenings is that they are best suited to detect slow-growing non-malignant tumors. If you get an annual mammogram and find a small lump, there’s a good chance that it grew slowly over the course of the year and will never pose a problem. However, fast-growing malignant tumors can go from nonexistent to unstoppable within much less than a year. So, you end up treating lots of the non-problems without greatly affecting the serious problems.
Gamecock, this has been going on for quite some time. The potential ramifications of overdiagnosis have been discussed for decades. Not everything’s a conspiracy.
Not to mention the fact that the things being tested for have only a weak correlation to disease (arbitrarily-defined cholesterol levels, marginally high blood pressure and blood glucose levels) which makes almost everyone “sick” and needing treatment with – hey presto – my new expensive drug!
The other side of this is the level of false positives in relation to the level of real incidence. If you have to test 1,000 people to find a single case (not unlikely, given the low levels of incidence of many diseases), but have a 1 per cent error rate, you will diagnose 10 healthy people as sick for every single person correctly diagnosed! This is the basis for the prostate and colon cancer explosion and may also account for the lack of impact on death rates from all of the breast cancer screening. We treat lots of people who would not have died or maybe even got sick from the disease, but still don’t have any impact on the baseline of the life-threatening incidences.
The concept of preventing expensive illnesses appeals to almost everybody. Yes, those providing screening services such as mammography benefit financially, but questioning their motivation to save lives of women is too harsh on them.
The data against mammograms between ages 40 and 50 was very clear to me 20 years ago. An expert group recently looked at all available data and came to the my conclusion. Their well thought out recommendation was overridden by the tragically foolish Senator Barbara Milkulski. The efficacy of mammograms at age 50 isn’t that good either. One fellow wrote a book that argues against all mammograms. He had a good case. The false alarm, “We need a biopsy Ms. Jones”, scares the daylights out of the Ms. Jones of the world.
Prep for Obamacare. They don’t want to pay for screening. Expect more
“screening is worthless” stories.
Something is wrong here. If you feel o.k., you aren’t o.k. because you are mentally disturbed. The government and its NGO supporters can’t have the public feel o.k.