Dangers in Early Detection By H. Gilbert Welch
View Full Version : Dangers in Early Detection By H. Gilbert Welch
Here's an article by a doctor who is skeptical of the big
medico consortium of test ordering providers, test producing
diagnostic companies and labs, and big pharma.
This is another physician that Doc Biggs will disparage. He
is part of this consortium. I'm here for my HEALTH-he's here
to justify his BUSINESS practices belittle skeptics of his
ALMIGHTINESS.
I just received my latest A1C-5.5 on a labnorm of 4.3 to
5.9, guess I'm doing my part as a T1 after 42 years.
2x Hypurin Lente mixed with Iletin II Regular.
You feel well. You're only 60. Your PSA -- the blood test
for prostate cancer -- is normal. Much to your chagrin, you
learn of recent research that suggests you still might have
prostate cancer. But the only way researchers know this is
because they performed a more aggressive test -- placing a
probe through the rectum of normal men and inserting a
biopsy needle six, maybe 12 times to search for cancer in
various parts of their prostate. Should this procedure be
performed on you? Should it be performed on all healthy men?
This is American medical care today -- care increasingly
directed toward the well. Ironically, the primary service
we offer them is relentless testing to establish whether
they are, in fact, sick. We screen for early forms of
diabetes, heart disease, osteoporosis, hepatitis, vascular
disease and, of course, cancer. The conventional wisdom is
that early detection improves health. But this assumption
may be wrong.
Why? Because early disease detection means more people
become patients. Inevitably some will be treated needlessly
and suffer as a result.
To understand this, you need to understand that each of us
harbors early forms of disease. Even in middle age, many of
us who feel well have evidence of diabetes, heart disease,
osteoporosis, hepatitis, vascular disease and cancer. Just
because we harbor these early forms of disease doesn't mean
that they will ever affect our health. Some diseases
progress so slowly that people die of other causes long
before the diseases generate symptoms. Other diseases may
not progress at all. Unless we were tested, we'd never have
known we were sick.
Prostate cancer is the classic example. Among men age 60,
around half have microscopic evidence of prostate cancer
if we look hard enough. Yet only four in 1,000 will die
from prostate cancer in the next 10 years. How can this
be? Because prostate cancer isn't just one disease: It's a
spectrum of disorders. Some forms of prostate cancer grow
very rapidly and kill men. Some grow slowly and men die of
something else before the cancer ever causes symptoms. And
others look like cancer under the microscope but never
grow at all.
A little over a decade ago, doctors started looking hard for
prostate cancer using the PSA and lots of needle biopsies.
And we found a great deal: Roughly 2 million cases were
diagnosed in this period -- almost a million more than would
have been without the test.
Did prostate cancer screening help men? To be honest, we
aren't sure about the net effect. There has been a small
decline in the death rate from prostate cancer, but this may
simply reflect that our treatments are better. While
screening probably has helped a few men live longer, it has
also clearly hurt others. Millions have been biopsied who
otherwise wouldn't have been. Many with nonprogressive
disease have been turned into cancer patients unnecessarily.
Most have been treated, and many have suffered ill effects.
A few have even had their lives shortened by treatment.
This is the reality of early detection. A few may be
helped, because their disease is destined to cause problems
and because early treatment is able to solve those problems
in a way that later treatment cannot. But many simply are
told earlier that they have a disease and gain nothing,
because their disease could have been treated just as well
later, when symptoms appeared. And others are hurt by
treatment for a disease that would have otherwise never
affected their health.
What's next? Consider CAT scans of the chest to look for
lung cancer. During mass screenings in one region of Japan,
CAT scans found 10 times as many patients with lung cancer
as had been found a few years earlier using chest X-rays.
Incredibly, nonsmokers were almost as likely to have lung
cancer as smokers. Is smoking getting safer? Of course not.
Everyone agrees that smoking is far and away the most
important cause of lung cancer. The CAT scans were simply
labeling some people as lung cancer patients who otherwise
would never be affected by a few abnormal cells.
Why not treat these patients -- just to be safe? Because
some people die from treatment. In the Mayo Clinic study
comparing lung cancer screening (using chest X-rays) to
standard care, more people in the screening group were told
that they had lung cancer. It didn't help them live longer;
in fact, slightly more people in that group died.
And some think we should scan the whole body. But the
harder we look, the more we find. CAT scans of the chest
lead more people to be told they have lung cancer, and
there are even more abnormalities to find in the abdomen.
As one radiologist who has read thousands of these scans
put it, "With this level of information, I have yet to see
a normal patient."
Millions of healthy Americans are being told that they are
sick (or "at risk"). More are undergoing invasive
evaluations with needles, flexible scopes and catheters.
And more are taking drugs for early forms of diabetes,
heart disease, osteoporosis, hepatitis, vascular disease
and cancer.
We need to start asking hard questions about whose interests
are served by the relentless pursuit of disease in people
who are well. Clearly it's good business -- for test
manufacturers, hospitals, pharmaceutical companies. And it's
good for some doctors.
But is it in society's interest? Many suggest that it saves
money by lowering the cost per patient. But the savings per
patient (if they exist) are overwhelmed by the increased
expense of having so many more to treat. Is it in the
interest of sick patients? Absolutely not, as caring for the
well increasingly distracts doctors from caring for the
truly sick. And what about the well? Is it in their
interest? Only they can decide -- after they have been
informed that early detection is a double-edged sword.
The writer is a professor of medicine in the Department of
Veterans Affairs and Dartmouth Medical School. He is the
author of "Should I Be Tested for Cancer? Maybe Not and
Here's Why." http://www.washingtonpost.com/wp-dyn/articles/A19323-
2004Jun30.html
BigNascarFan wrote:
> Here's an article by a doctor who is skeptical of the big
> medico consortium of test ordering providers, test
> producing diagnostic companies and labs, and big pharma.
>
> This is another physician that Doc Biggs will disparage.
> He is part of this consortium. I'm here for my HEALTH-he's
> here to justify his BUSINESS practices belittle skeptics
> of his ALMIGHTINESS.
>
> I just received my latest A1C-5.5 on a labnorm of 4.3 to
> 5.9, guess I'm doing my part as a T1 after 42 years.
>
> 2x Hypurin Lente mixed with Iletin II Regular.
>
>
>
> You feel well. You're only 60. Your PSA -- the blood test
> for prostate cancer -- is normal. Much to your chagrin,
> you learn of recent research that suggests you still might
> have prostate cancer. But the only way researchers know
> this is because they performed a more aggressive test --
> placing a probe through the rectum of normal men and
> inserting a biopsy needle six, maybe 12 times to search
> for cancer in various parts of their prostate. Should this
> procedure be performed on you? Should it be performed on
> all healthy men?
>
> This is American medical care today -- care increasingly
> directed toward the well. Ironically, the primary service
> we offer them is relentless testing to establish whether
> they are, in fact, sick. We screen for early forms of
> diabetes, heart disease, osteoporosis, hepatitis, vascular
> disease and, of course, cancer. The conventional wisdom is
> that early detection improves health. But this assumption
> may be wrong.
>
> Why? Because early disease detection means more people
> become patients. Inevitably some will be treated
> needlessly and suffer as a result.
>
> To understand this, you need to understand that each of us
> harbors early forms of disease. Even in middle age, many
> of us who feel well have evidence of diabetes, heart
> disease, osteoporosis, hepatitis, vascular disease and
> cancer. Just because we harbor these early forms of
> disease doesn't mean that they will ever affect our
> health. Some diseases progress so slowly that people die
> of other causes long before the diseases generate
> symptoms. Other diseases may not progress at all. Unless
> we were tested, we'd never have known we were sick.
>
> Prostate cancer is the classic example. Among men age 60,
> around half have microscopic evidence of prostate cancer
> if we look hard enough. Yet only four in 1,000 will die
> from prostate cancer in the next 10 years. How can this
> be? Because prostate cancer isn't just one disease: It's a
> spectrum of disorders. Some forms of prostate cancer grow
> very rapidly and kill men. Some grow slowly and men die of
> something else before the cancer ever causes symptoms. And
> others look like cancer under the microscope but never
> grow at all.
>
> A little over a decade ago, doctors started looking hard
> for prostate cancer using the PSA and lots of needle
> biopsies. And we found a great deal: Roughly 2 million
> cases were diagnosed in this period -- almost a million
> more than would have been without the test.
>
> Did prostate cancer screening help men? To be honest, we
> aren't sure about the net effect. There has been a small
> decline in the death rate from prostate cancer, but this
> may simply reflect that our treatments are better. While
> screening probably has helped a few men live longer, it
> has also clearly hurt others. Millions have been biopsied
> who otherwise wouldn't have been. Many with nonprogressive
> disease have been turned into cancer patients
> unnecessarily. Most have been treated, and many have
> suffered ill effects. A few have even had their lives
> shortened by treatment.
>
> This is the reality of early detection. A few may be
> helped, because their disease is destined to cause
> problems and because early treatment is able to solve
> those problems in a way that later treatment cannot. But
> many simply are told earlier that they have a disease and
> gain nothing, because their disease could have been
> treated just as well later, when symptoms appeared. And
> others are hurt by treatment for a disease that would have
> otherwise never affected their health.
>
> What's next? Consider CAT scans of the chest to look for
> lung cancer. During mass screenings in one region of
> Japan, CAT scans found 10 times as many patients with
> lung cancer as had been found a few years earlier using
> chest X-rays. Incredibly, nonsmokers were almost as
> likely to have lung cancer as smokers. Is smoking getting
> safer? Of course not. Everyone agrees that smoking is far
> and away the most important cause of lung cancer. The CAT
> scans were simply labeling some people as lung cancer
> patients who otherwise would never be affected by a few
> abnormal cells.
>
> Why not treat these patients -- just to be safe? Because
> some people die from treatment. In the Mayo Clinic study
> comparing lung cancer screening (using chest X-rays) to
> standard care, more people in the screening group were
> told that they had lung cancer. It didn't help them live
> longer; in fact, slightly more people in that group died.
>
> And some think we should scan the whole body. But the
> harder we look, the more we find. CAT scans of the chest
> lead more people to be told they have lung cancer, and
> there are even more abnormalities to find in the abdomen.
> As one radiologist who has read thousands of these scans
> put it, "With this level of information, I have yet to see
> a normal patient."
>
> Millions of healthy Americans are being told that they are
> sick (or "at risk"). More are undergoing invasive
> evaluations with needles, flexible scopes and catheters.
> And more are taking drugs for early forms of diabetes,
> heart disease, osteoporosis, hepatitis, vascular disease
> and cancer.
>
> We need to start asking hard questions about whose
> interests are served by the relentless pursuit of disease
> in people who are well. Clearly it's good business -- for
> test manufacturers, hospitals, pharmaceutical companies.
> And it's good for some doctors.
>
> But is it in society's interest? Many suggest that it
> saves money by lowering the cost per patient. But the
> savings per patient (if they exist) are overwhelmed by
> the increased expense of having so many more to treat.
> Is it in the interest of sick patients? Absolutely not,
> as caring for the well increasingly distracts doctors
> from caring for the truly sick. And what about the well?
> Is it in their interest? Only they can decide -- after
> they have been informed that early detection is a double-
> edged sword.
>
> The writer is a professor of medicine in the Department of
> Veterans Affairs and Dartmouth Medical School. He is the
> author of "Should I Be Tested for Cancer? Maybe Not and
> Here's Why." http://www.washingtonpost.com/wp-dyn/articles/A19323-
> 2004Jun30.html
SOME of the points outlined have some validity, BUT I sure
as hell wished my DM was caught MANY years before I was
diagnosed. I'd love to jump into a time machine and go back
several years BEFORE my '78 diagnosis and DEMAND a
definitive test for DM. I had all the classic symptoms for
so long before my diagnosis, it's a wonder I didn't
completely fall apart.
Society is a group who's members have individual interests
that others would just as soon not cater to. When you talk
about society, don't confuse that concept with the
individual members who make up "society". Look at the cost
of socialized medicine, ala the UK or some European
countries. The level of care is often inadequate, and S-L-O-
W, even for life threatening illnesses. "Society", being the
group, may have everyone "covered" by the program, but
individuals die each day, waiting for treatment.
dave
On Fri, 02 Jul 2004 22:02:52 GMT, BigNascarFan
<nascarNOLOSPAMOLOlarge@att.net> wrote: <snip>
>This is the reality of early detection. A few may be
>helped, because their disease is destined to cause problems
>and because early treatment is able to solve those problems
>in a way that later treatment cannot. But many simply are
>told earlier that they have a disease and gain nothing,
>because their disease could have been treated just as well
>later, when symptoms appeared. And others are hurt by
>treatment for a disease that would have otherwise never
>affected their health.
<snip>
I don't doubt that there is sometimes an excessive over-
reaction, both by the medical fraternity and some
hypochondriac patients. These are valid comments if they
force critical review of the medical need (NOT the financial
implications) for accurate diagnostic criteria.
However, I see this sort of generalised comment also as an
over-reaction. The comments this author makes about the
"others that are hurt by the treatment" in no way balance
the "few" that may be helped. However, it may mean that the
methods and intervention points of treatment need review
rather than the criteria for diagnosis.
This sort of statement instantly brings to mind the comments
and resistance we get from some sectors of the medical
fraternity concerned about the "obsession" that some of us
have with "self-testing" and how harmful this "excessive"
testing is to our psyches.
It is likely that I would not have been diagnosed, with
either leukaemia or diabetes, under the old standards in
place ten years ago. But the tighter standards used today
led to my diagnosis in early '02. The diagnosis did lead to
depression, but I survived that. If I hadn't been diagnosed
I would now be 25 Kg (55 lbs) heavier, have soaring
triglycerides and constant hyperglycemia; although that's
probably false because it's more likely I'd be dead.
The spiteful remarks on another poster are not worthy
of rebuttal.
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.
BNF,
So who *is* the author ? Apparently that part got
chopped off.
Send me the name & address on that consortium. I must have
misplaced it. ;)
Cheers,
William C Biggs, MD
"BigNascarFan" <nascarNOLOSPAMOLOlarge@att.net> wrote in message:
> This is American medical care today -- care increasingly
> directed toward the well. Ironically, the primary service
> we offer them is relentless testing to establish whether
> they are, in fact, sick. We screen for early forms of
> diabetes, heart disease, osteoporosis, hepatitis, vascular
> disease and, of course, cancer. The conventional wisdom is
> that early detection improves health. But this assumption
> may be wrong.
>
> <snip>
Very interesting BigFan, I think there is definitely
something to what you have posted. From a psychological
point of view it can be difficult to separate things in our
minds especially in new or unfamiliar situations so that we
have to relay on preconceptions somewhat, or taking things
at face value. So we know: workers go to work, pupils go to
school, sick people go to the hospital- You go to the hospital-
therefore you must be sick.
Personally I think- Hospitals are full of people who are
brimming with nasty germs I have a below average immune
system hospitals should be avoided whenever possible.
Citizen D_M
>Society is a group who's members have individual interests
>that others would just as soon not cater to. When you talk
>about society, don't confuse that concept with the
>individual members who make up "society". Look at the cost
>of socialized medicine, ala the UK or some European
>countries. The level of care is often inadequate, and S-L-O-
>W, even for life threatening illnesses. "Society", being
>the group, may have everyone "covered" by the program, but
>individuals die each day, waiting for treatment.
>
>
>dave
Living in a country where health care is free I must agree
with free=poor, inaccurate, downright lousy.
Allthough I could get free health care I sure as hell steer
clear from the "free" service lest I want to wait in line
for five hours get to see someone who is way underqualified
to do anything. The sad thing about free health service that
it actually costs a helluva lot more than "commercial"
health care. The free health care sector is very, very
inefficient and rife with corruption and whatnot. Oh, and
free means you still have to pay! The free part has been
eroding year after year and now you have to pay all sorts
cost to get the "free" service.
I know many health care people and they are wonderful,
caring people. It's just that the system is corrupt.
On Sat, 3 Jul 2004 22:49:05 +0100, "Citizen DM"
<mail@defeatspam.com> wrote: <snip>
>Personally I think- Hospitals are full of people who are
>brimming with nasty germs I have a below average immune
>system hospitals should be avoided whenever possible.
>
>Citizen D_M
That's an opinion I thoroughly endorse. With Igs in the
toilet it's one reason I do everything I can to stay out of
hospitals.
And I don't wait in "waiting rooms". I've trained my various
doc's receptionists that I will be outside in the lobby or
car-park when my appointment time comes, not sitting beside
all the sniffles and sneezes or thumbing through old
magazines just put down by diseased hands.
It took a while and development of some rapport, but my
local doc's surgery is five minutes drive; the receptionist
now rings me at home when the patient before me goes in.
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.
Total bull****
In the US, health care spending per capita is over 6 times
what it is in the UK, in fact, the FEDERAL government alones
spending on healthcare, which is only government employee,
military, veterans, Medicare, and a tiny portion of title
19, when divided by all US residents is STILL more per
capita than the UK spends for full health care.
This provides, by far, the worst mortality and morbidity
rates of any developed country.
As to waiting, the portion of the country which is fortunate
enough to have insurance has to wait many hours for service,
then get a bunch of expensive tests and 30 seconds with a
doctor. Do to the increasing medical costs, 75% of people
who are unable to pay their medical bills are INSURED.
Copays deductibles and corridor fees are rising even faster
than insurance rates..
As for the rest, well, 20% of all Americans can not get
health coverage at all, not Medicare, not medicaid, NOTHING.
They are mainly untreated. If it gets bad enough, they come
into an emergency room under a false name. ER waits here,
for walk ins, are over 12 hours!
In addition to the rising number of uninsured, another 31
million Americans were temporarily without insurance during
the last two years. Mainly due to being laid off, or
changing job. "Temporarily" means no less than one month, no
more than 23 months. Average around 8 months.
ppp wrote:
>>Society is a group who's members have individual interests
>>that others would just as soon not cater to. When you talk
>>about society, don't confuse that concept with the
>>individual members who make up "society". Look at the cost
>>of socialized medicine, ala the UK or some European
>>countries. The level of care is often inadequate, and S-L-O-
>>W, even for life threatening illnesses. "Society", being
>>the group, may have everyone "covered" by the program, but
>>individuals die each day, waiting for treatment.
>>
>>
>>dave
>
>
> Living in a country where health care is free I must agree
> with free=poor, inaccurate, downright lousy.
>
> Allthough I could get free health care I sure as hell
> steer clear from the "free" service lest I want to wait in
> line for five hours get to see someone who is way
> underqualified to do anything. The sad thing about free
> health service that it actually costs a helluva lot more
> than "commercial" health care. The free health care sector
> is very, very inefficient and rife with corruption and
> whatnot. Oh, and free means you still have to pay! The
> free part has been eroding year after year and now you
> have to pay all sorts cost to get the "free" service.
>
> I know many health care people and they are wonderful,
> caring people. It's just that the system is corrupt.
--
"...in addition to being foreign territory the past is, as
history, a hall of mirrors that reflect the needs of souls
observing from the present" Glen Cook
On Sat, 03 Jul 2004 17:04:57 +0300, ppp <dont@send.mail.com> wrote:
>>
>>Society is a group who's members have individual interests
>>that others would just as soon not cater to. When you talk
>>about society, don't confuse that concept with the
>>individual members who make up "society". Look at the cost
>>of socialized medicine, ala the UK or some European
>>countries. The level of care is often inadequate, and S-L-O-
>>W, even for life threatening illnesses. "Society", being
>>the group, may have everyone "covered" by the program, but
>>individuals die each day, waiting for treatment.
>>
>>
>>dave
>
>Living in a country where health care is free I must agree
>with free=poor, inaccurate, downright lousy.
>
>Allthough I could get free health care I sure as hell steer
>clear from the "free" service lest I want to wait in line
>for five hours get to see someone who is way underqualified
>to do anything. The sad thing about free health service
>that it actually costs a helluva lot more than "commercial"
>health care. The free health care sector is very, very
>inefficient and rife with corruption and whatnot. Oh, and
>free means you still have to pay! The free part has been
>eroding year after year and now you have to pay all sorts
>cost to get the "free" service.
>
>I know many health care people and they are wonderful,
>caring people. It's just that the system is corrupt.
You are either a shill or extremely brainwashed by the
greedy part of the health care BUSINESS.
I have experienced every item you quote as problems with any
other system plus gross excess cost.
So many good docs, but the other aggressive bums are
creating a real dissatisfaction
Diabetes is one of many diseases that requires a lot of
time. We are here because we must depend on ourselves.. One
minute at $1000 per hour is not bearable. But the result has
been a very big negative for me. These groups were a life
saver for me. LITERALLY. Take your line to the local club
house were the fees are about $50K per year. That is where
it belongs.
There. is free medicine. I know as many wealthy people on
that teat as there are very poor people using it, I can
observe it without leaving my porch. That is a separate
issue. A universal system would be a great equalizer where
every one paying a fair share..But I must admit the hustlers
would find some way.
We now have so many going to the docs office for a hobby.
The answer is not to make the docs office a luxury
environment. with music and art. Now those that demand that
should pay out of pocket for that service.
Health care as always been a problem. Now we have a
situation in the US that is gross. The fools have a good
deal but demand more and more. for less and less.
And too many cases finding a disease where it is better to
not treat it.
On Sat, 03 Jul 2004 17:04:57 +0300, ppp <dont@send.mail.com> wrote:
>Living in a country where health care is free I must agree
>with free=poor, inaccurate, downright lousy.
Which country?
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.
This is a big YMMV subject. I pay about $600 a year for
Medicare. My work place pays about $6000 s year for Blue
Cross. Of course I have to earn the income which pays Blue
Cross, but the office gets to deduct it, too. (And anti-
capitalists please note that a little personal service
corporation has a 35% tax rate! So we grab any valid
deductions we can get!). I picked my own doctors.
Occasionally I have to wait an hour but they also spend an
hour on me. Pay maybe $200 a year in "extras" (Wierd that
neither insurance pays for annual physicals.) Bypass surgery
several years ago cost nearly $100,000 of which I paid
NOTHING. Drug costs are somewhat painful but on the whole,
no complaints. Nan, Type 2, age 76
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