Comments on: Cost/Benefit Analysis

By: Zane

Zane — Thu, 26 Nov 2009 22:27:12 +0000

late, don’t know if you’ll see this. Down near Peterborough, but have family in Newcastle (South Shields). Perhaps a trip across Midlothian and I’ll buy you a beer.

By: Tom

Tom — Tue, 24 Nov 2009 00:17:36 +0000

Thanks, and likewise. I’m at Edinburgh. Where is your UK trip taking you?

By: Zane

Zane — Mon, 23 Nov 2009 20:06:00 +0000

Tom, thanks for the thoughtful response. I’m on the move to the UK in two weeks, may I ask where you’re studying?

By: Oh Hell

Oh Hell — Mon, 23 Nov 2009 18:43:05 +0000

I don’t object to having recommendations for care modified. What I do object to is the government deciding what treatments I can and cannot have even if I am footing the bill. The people making these decisions are not my doctor and the decisions they make will not impact their lives, only mine. Most of them have no medical background either, they are bean counters not medical professionals. Their ultimate goal is not health care or even health insurance, it is control.

By: Tom

Tom — Mon, 23 Nov 2009 17:34:16 +0000

(Split in two: didn’t want to hog space.)

Here’s a cochrane review on the matter (http://www.ncbi.nlm.nih.gov/pubmed/17054145?ordinalpos=1&itool=PPMCLayout.PPMCAppController.PPMCArticlePage.PPMCPubmedRA&linkpos=5) which should be open access.

Your point about age is well taken: I can’t work out the age parameters from that article I posted. Here women are routinely invited for triennial screening between their late 40′s and 73 (although risk factors such as family history or just plain requests will of course change that). So if overdiagnosis is a problem in this middle aged to elderly testing group, I can only imagine that its more significant a problem the lower the population wide risk.

I certainly don’t want to claim any special knowledge off the back of one semester of med school and i’m no knee-jerk defender of my nation’s health care practises – it just seems to me that the suggestion the U.S. Preventive Services Task Force made (that screening be discussed in terms of harm/benefit rather than being automatic in this age range)is a sensible response to the evidence for tangible harm from overdiagnosis that is accumulating.

By: Tom

Tom — Mon, 23 Nov 2009 17:12:36 +0000

Zane, sorry for the confusion, I forgot to add quote marks around my middle paragraph, which was a direct excerpt from the paper, rather than intended as a summary. I’ve also realized that bmj articles which appear as open access through my institution’s network may not be available to everyone due to subscription issues, sorry if thats so. In case it should be, I’ve pasted in a chunk from this editorial below(BMJ 2009;339:b1425). British spelling I’m afraid.

“Overdiagnosis refers to the detection of abnormalities that will never cause symptoms or death during a patient’s lifetime. Overdiagnosis of cancer occurs when the cancer grows so slowly that the patient dies of other causes before it produces symptoms or when the cancer remains dormant (or regresses). Because doctors don’t know which patients are overdiagnosed, we tend to treat them all. Overdiagnosis therefore results in unnecessary treatment.

With the advent of widespread efforts to diagnose cancer earlier, overdiagnosis has become an increasingly vexing problem. Overdiagnosis is a widely recognised problem in prostate cancer screening, and it has also been reported in other cancers, including neuroblastoma, melanoma, thyroid cancer, and lung cancer. Some degree of overdiagnosis is likely to be the rule rather than the exception in cancer screening.

Jørgensen and Gøtzsche’s results are consistent with a growing body of observational evidence that screening mammography is associated with sustained increases in the incidence of breast cancer in women of screening age, with little or no subsequent decrease in incidence in older women. One cohort study concluded that some invasive breast cancers detected by screening must spontaneously regress.7″