Striking the balance – avoiding overtreatment

overmed

In medicine, more is not always better.

The more we look the more we find. Most health people will be a little abnormal if we look hard enough.  Much of what we find (the cyst on the kidney, the high PSA, the nodule on the thyroid…) will never cause harm, but once it’s found it can’t be ignored. So more test, medicines and procedures result with their attendant risk.

A new study revealed: “the risk of a malpractice claim against internal medicine specialists ranged from 1.5 percent among those in the bottom fifth of patient spending ($19,725 per hospital admission) to 0.3 percent among those in the top fifth of spending ($39,379 per hospital admission).” So the doctors who spend less are sued 5 times as much.

So in America for this and a host of other reasons, doctors do too many tests.  Much of this extra testing does not lead to better outcomes or health.   More people are labeled diseased or with “abnormal” findings, but to what end? Doctors know this doesn’t make sense, but also know most patients (at least well insured ones) feel more satisfied when they get more done.

Yellow brick road myths about medical care
1 – All risks can be lowered
2 – It’s always better to fix the problem
3 – Sooner detection is always better
4 – It never hurts to get more information
5 – Action is always better than inaction
6 – Newer is always better
7 – It’s all about avoiding death

When a cancer is removed, a patient will feel their life was saved. But for many patients the cancer would have never harmed them.  The cancer was too slow growing to go anywhere, and their surgery was unnecessary.  Get on the right road, and consider the risks as well as benefits of every intervention.

Consider prostate cancer screening. The PSA test for prostate cancer is a gamble. There are some winners but also some losers.

Nearly 70% of men in their 60s, and over 80% of men in the 70s have prostate cancer.  For most it will not cause harm, they will die of something else. For some it will.

There have been 2 large studies on how well screening with PSA works. The European study showed a statistically significant 20% reduction in prostate cancer mortality in the screen group.  The US study showed a non-significant 13% increase in prostate cancer mortality in the screened group.  So the American study said the PSA has no net benefit,

Using the European study data, 50 men will be overdiagnosed with prostate cancer for every life saved.  Overdiagnosed means that were their cancers left alone, they would never harm them.  Overdiagnosis leads to unnecessary surgery and radiation which cause incontinence and impotence.

Does it matter? Absolutely. Overdiagnosis leads to unnecessary radical surgery or radiation. Roughly a third will suffer side effects of treatment—generally related to bowel, bladder, or sexual function. And a few will die from it.  But for a small percentage, screening saves their lives.

Overdiagnosed – bad for you, good for business

Before getting treatment watch this very important Australian documentary.

overdiagnosed video

 

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2 thoughts on “Striking the balance – avoiding overtreatment

  1. Pingback: Breast Screening Guidelines for women in the 40s have gotten more confusing. | Road 2 Liberty

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