Medicine
I'm traveling to Boston tomorrow to participate in a panel discussion on Friday for this year's William J. Bicknell Lectureship at the Boston University School of Public Health. The keynote speaker is H. Gilbert Welch, MD, MPH, author of the books Should I Be Tested For Cancer? Maybe Not and Here's Why and Overdiagnosed: Making People Sick in the Pursuit of Health, which I reviewed in a previous blog post. Here's an excerpt to give you a flavor of that review:
As H. Gilbert Welch and colleagues argue convincingly in their new book, ... much of the rise in cancer diagnoses over the past several decades has been the result of overdiagnosis: the detection (through screening or incidental finding on medical images obtained for other reasons) of cancers that would otherwise never have caused problems for patients. In the absence of screening, patients would not have developed symptoms because the "cancer" would not have progressed, or the patient was destined to die from some other cause (typically, heart disease). In the presence of screening, however, they suffer the psychological effects of knowing that they have cancer, the complications of diagnostic procedures, and the consequences of unnecessary treatments.
Seen in this light, the rise in cancer survivorship is not a modern medical success story. For millions of patients who received diagnoses that they didn't need and would do nothing to improve their health, it is a catastrophe.
- More On Mammography: Just Because You Don't Like The Results Doesn't Make Research Junk Science
A recent study published in the New England Journal of Medicine, “Effect of three decades of screening mammography on breast-cancer incidence”, by Archie Bleyer and H. Gilbert Welch[1], has generated enormous controversy. This has been caused by...
- The Good News, At Last, In Prostate Cancer Screening
As I previously documented in a series of posts on this blog, the road to the U.S. Preventive Service Task Force's 2012 "don't do it" recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls....
- Conservative Medicine: Why Am I The Best Person To Write It?
In a recent New York Times editorial about exorbitant healthcare costs, Dartmouth professor H. Gilbert Welch (the author of Overdiagnosed: Making People Sick in the Pursuit of Health) asserted: "Medical care in America could use a dose of moral outrage."...
- Should You Be Screened For Lung Cancer? Maybe Not, And Here's Why
If you are a lifelong heavy smoker age 55 years or older, the U.S. Preventive Services Task Force believes that screening for lung cancer with CT scans may save your life. Today the Task Force released provisional recommendations that assigned a...
- Should Screening Mammography Always Be A Shared Decision?
In the February 15th issue of American Family Physician, Dr. Maria Tirona reviews areas of agreement and disagreement in major organizational guidelines on screening for breast cancer. There is widespread consensus that annual or biennial mammography...
Medicine
"Making people sick in the pursuit of health"
I'm traveling to Boston tomorrow to participate in a panel discussion on Friday for this year's William J. Bicknell Lectureship at the Boston University School of Public Health. The keynote speaker is H. Gilbert Welch, MD, MPH, author of the books Should I Be Tested For Cancer? Maybe Not and Here's Why and Overdiagnosed: Making People Sick in the Pursuit of Health, which I reviewed in a previous blog post. Here's an excerpt to give you a flavor of that review:
As H. Gilbert Welch and colleagues argue convincingly in their new book, ... much of the rise in cancer diagnoses over the past several decades has been the result of overdiagnosis: the detection (through screening or incidental finding on medical images obtained for other reasons) of cancers that would otherwise never have caused problems for patients. In the absence of screening, patients would not have developed symptoms because the "cancer" would not have progressed, or the patient was destined to die from some other cause (typically, heart disease). In the presence of screening, however, they suffer the psychological effects of knowing that they have cancer, the complications of diagnostic procedures, and the consequences of unnecessary treatments.
Seen in this light, the rise in cancer survivorship is not a modern medical success story. For millions of patients who received diagnoses that they didn't need and would do nothing to improve their health, it is a catastrophe.
BU Today just published a nice interview with Dr. Welch that connects the theme of overdiagnosis with the U.S. Preventive Services Task Force's recent draft recommendation against PSA screening for prostate cancer and his sobering new paper in the Archives of Internal Medicine that estimates the likelihood that a patient with screen-detected breast cancer has had her "life saved" to be less than 15 percent.
I am very much looking forward to meeting Dr. Welch and fellow panelists Deborah Bowen and John Fallon and having a terrific discussion!
- More On Mammography: Just Because You Don't Like The Results Doesn't Make Research Junk Science
A recent study published in the New England Journal of Medicine, “Effect of three decades of screening mammography on breast-cancer incidence”, by Archie Bleyer and H. Gilbert Welch[1], has generated enormous controversy. This has been caused by...
- The Good News, At Last, In Prostate Cancer Screening
As I previously documented in a series of posts on this blog, the road to the U.S. Preventive Service Task Force's 2012 "don't do it" recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls....
- Conservative Medicine: Why Am I The Best Person To Write It?
In a recent New York Times editorial about exorbitant healthcare costs, Dartmouth professor H. Gilbert Welch (the author of Overdiagnosed: Making People Sick in the Pursuit of Health) asserted: "Medical care in America could use a dose of moral outrage."...
- Should You Be Screened For Lung Cancer? Maybe Not, And Here's Why
If you are a lifelong heavy smoker age 55 years or older, the U.S. Preventive Services Task Force believes that screening for lung cancer with CT scans may save your life. Today the Task Force released provisional recommendations that assigned a...
- Should Screening Mammography Always Be A Shared Decision?
In the February 15th issue of American Family Physician, Dr. Maria Tirona reviews areas of agreement and disagreement in major organizational guidelines on screening for breast cancer. There is widespread consensus that annual or biennial mammography...