Wednesday, October 26, 2011

"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!