Being the Jewish New year (5772 since the world was created, of course), although I am totally secular, I find myself taking a couple days off my “Denisovich” lifestyle to visit with family. It seems that one of the main wishes for new year, be it Jewish, Christian or other religions–at least those with which I have some vague familiarity–is for a “happy and healthy new year.”
We can all argue what “happy is about”–for some of us it’s getting off work and heading to the pub for some pints, for others, it’s family life, and for others still, taking work home and being “happy as a pig in sh*t.” But how do we define healthy? And more specifically, how do we stay healthy?
I think there is a lot to be said that the evidence is out there. Smokers can expect a 10 y average reduction in lifespan, not to mention life quality. The same goes for obesity, which dramatically increases the likelihood of succumbing to a variety of diseases that go well beyond diabetes and heart disease. Today good evidence exists for increased risk for a variety of GI-based and other cancers. Perhaps it’s not the obesity per se, but the tendency of obese people to eat certain foods that increase risk. The jury is still out on those issues, but the risks are fairly clear.
Well, what about preventive medicine? Here’s where I came across an article in Newsweek some time ago–the type of article that I don’t often have time to read. This one, entitled “No! The one word that can save your life” was written by Sharon Begley (Aug. 22/29 edition, 2011), whose articles about science and medicine I think are generally pretty good.
Not this one.
The underlying premise of this article is that there are too many medical tests being done–not just an issue of saving money, but rather tests that confuse and ultimately lead to more harm than help. The author takes as an example a Professor (Emeritus) of family medicine at Brown University who tells his own physician not to order PSA tests for prostate cancer screening or electrocardiograms for heart irregularities. She cites a Professor of Medicine, Dr. Redberg, at UCSF who maintains that mammograms are not worth doing because they detect too many false positives. The latter notes that “There are many areas of medicine where not testing, not imaging and not treating actually result in better health outcomes.”
Many of the examples given are of the anecdotal nature, about which much has been said in this blog on OT and others. The elderly woman who had her colon perforated by an unnecessary colonoscopy and died. But as distasteful as my hypochondriac nature views such a screening (recommended at age 50 in only a few years for me)–perhaps the little pill-camera gizmo will be in general use by then? Please!
In any event, there is no arguing that colonoscopies are for the most part very benign procedures that have saved many lives by early detection of colorectal cancer.
But let’s return for a moment to PSA testing. Infallible, it certainly isn’t. It’s well documented that there are a lot of false positives. There is even evidence that recent male ejaculation may alter blood PSA levels. While randomized trials and calculating statistics are complicated by a large number of factors, gliding through PubMed as a scientist without medical training, I find the evidence fairly conclusive that PSA screening is worthwhile. Especially when combined with a yearly digital prostate exam. One of a number of articles noted: “Men in the screening group in the European Randomized Study of Screening for Prostate Cancer were 20% less likely than those in the control group to die from prostate cancer. The absolute difference was only 0.7/1000, implying that over 1400 men needed to be screened to prevent one prostate cancer death. Screening was also associated with a 70% increased risk for being diagnosed with prostate cancer.” Those may not be wonderful odds, but if I were that 1 person out of 1400, I’d take it. Especially when all that’s needed is a tick by my physician on a form when doing a blood test anyway.
In this article, a battery of anecdotal cases are described–the woman who did a cardio CT and had plaques show up, and the ensuing medical tests led to a torn artery and ultimately a heart transplant.
In my humble opinion, this type of article only serves as a “scare tactic,” and does a disservice to medicine by warning off the not-as-well-informed population–something that is reminiscent of the anti-vaccine proponents.
Don’t get me wrong; I have no doubt that there are risks involved and inherent false positives in many of today’s largely accepted medical screening tests. I have heard a first-hand account of someone who decided to do a full-body scan, which identified a shadow on the lung. The subsequent biopsy led to infection and a very long and slow recovery from–what was essentially nothing. These cases do occur (and I’m not sure that full-body scans are on any physicians regular screening tests in any case), but they are not representative of the numerous procedures that are done–many of which prove useful.
I would charge that science journalists–particularly those with a wide following who are–in a way–serving as interpreters for the general public, would be wise to carefully weigh any anecdotal and emotionally compelling stories with statistical evidence.
Wishing you all a happy and healthy Jewish New Year.