Maybe some can remember (can I ?) the bird and swine-flu hype which made governments spend trillions on supposedly anti-viral medicines, which firstly were never needed, which secondly would have never worked because of a lack of efficacy and which thirdly had to be destroyed at more great expense after the date of expiry. The media were happily fueling this hype and created by this a public pressure on governments with the above mentioned consequences – anxiety sells and I think that after shedding some light on dark banking practices the print and visual media do certainly merit the same treat – anxiety sells. Any room for ethics here ?
But how about Medicine ? There are many medics who would surf on their patients fear about chronic illness, cancer and death and ‘sell’ an unnecessary amount of medical services – normally at great expense for the patient.
It is interesting that big American medical organizations like the US Medical Services Task Force started reviewing common screening habits like mammograms, cervical smears and PSA-testing and downgraded their importance to a degree that regular screening for the general population is not recommended anymore. The rationale behind this is the fact that most cancers detected by screening are benign or so small, that they would never have caused illness or death anyhow. In Norway for example they found that invasive breast cancer started declining before general mammography screening was implemented and therefore it cannot be attributed to the screening! The same applies to prostate cancer in the US.
We are talking statistics here, big numbers of whole nations and this naturally does not and cannot take into account the individual. But the individual is concerned and has fears about cancer – what to do? Naturally we will take the fears seriously and send him or her to test for it. Let’s take mammography for example: 2500 women undergo mammography, 30 cancers get detected of which 10 later on show characteristics such that they would never have become clinically significant. This represents 30% over-diagnosis with all the consequences of having to live with the diagnosis, undergo invasive treatments etc….
Modern medicines are powerful enough to treat a clinically significant condition.
Overusing diagnostic facilities can produce harm. Nowadays one is discussing, how many breast cancers are caused by overuse of mammography!
Professional experience and reason are necessary and diagnostic procedures such as blood tests and radiography are useful tools in a knowledgeable hand.
The big boss of the, in those times, biggest community hospital in Germany told us youngsters about a study he did : they sent 2 x-rays without any further clinical information to 20 renowned radiologists nationwide asking for a diagnosis. Of the 20 answers 10 were correct and 10 were incorrect. He commented it like this: “we could as well have thrown a coin – that’s how significant a radiography is without any further information. It is just one little piece of a big puzzle.”
And all the art is in assembling the puzzle with a knowledgeable hand and eye.