Does early diagnosis really save lives?
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Does early diagnosis really save lives?
Discuss what's in the BMJ and on bmj.com
Des Spence writes in the BMJ this week that "early diagnosis is simply screening rebranded." http://www.bmj.com/content/344/bmj.e4252 "Big pharma loves early diagnosis: it makes more patients who take
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Does early diagnosis really save lives?
posted at 21/6/2012 2:27 PM BST
on bmj.com
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*Moderator*
Posts: 1436
First: 7/4/2011 Last: 17/5/2013 |
Des Spence writes in the BMJ this week that "early diagnosis is simply screening rebranded." http://www.bmj.com/content/344/bmj.e4252 "Big pharma loves early diagnosis: it makes more patients who take more profitable drugs for their whole life. The other certain outcomes of early diagnosis are more testing, more referrals, and more interventions. In turn, these generate more non-progressive disease, “incidentalomas,” and overdiagnosis—impaling anxious patients with yet more fear and non-disease pathology, while the medical fatalists happily ignore all warnings. The thoughtless and emotional language of “early diagnosis” is in reality just bad screening and the worst science." Is this obsession about early diagnosis really saving many more lives? Or is it turning us all into patients? |
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Re: Does early diagnosis really save lives?
posted at 21/6/2012 3:00 PM BST
on bmj.com
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Posts: 2034
First: 12/3/2010 Last: 17/5/2013 |
Parellel article in this week's New Scientist (23/6/12) on Ductal Carcinoma In Situ of the breast. Is DCIS analogous to prostate cancer, so that watch'n'wait is appropriate, rather than immediate aggresive surgery? You can read the article here - you may have to register first: http://www.newscientist.com/article/mg21428700.300-cruel-cuts-is-all-breast-cancer-surgery-necessary.html? John |
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Re: Does early diagnosis really save lives?
posted at 22/6/2012 8:24 PM BST
on bmj.com
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Posts: 1784
First: 7/3/2009 Last: 18/5/2013 |
Come on. Of course early diagnosis saves lives. What you describe is a fraction of cases. We are talking about big things: A carcinoma insitu of colon, breast, skin, etc. discovered and removed saves lives. And so we can bring a lot of other examples. "Big pharma loves early diagnosis...etc." What are you referring to: cholesterol? hypertension? diabetes? No, these claims are ridiculous.Early diagnosis per se is not the reason for taking medications that make profit for big pharma companies. I would rather see 2000 "false alarms" than miss one cancer that can be diagnosed early and thus save the patients' life. I have plenty of examples after more than 20 years in profession.
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Re: Does early diagnosis really save lives?
posted at 22/6/2012 8:43 PM BST
on bmj.com
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Posts: 2034
First: 12/3/2010 Last: 17/5/2013 |
Duane, Yoram, Please read the NS article. Good clinicians and researchers are questioning that, and as I said above, what is the point of pursuing earlier and earlier diagnosis of, say, prosatatic carcinoma? 80% of men over 80 have prostatic carcinoma in situ, yet they mostly die of something else. I can't say how relevant that is to breats or colonic CIS. The question is not , "Is cancer best treated early?" but "WHICH cancers need early detetction and treatment?" JOhn |
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Re: Does early diagnosis really save lives?
posted at 22/6/2012 9:59 PM BST
on bmj.com
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Posts: 1784
First: 7/3/2009 Last: 18/5/2013 |
John, this is the question, but.... there is a big "but" here. I hate when people bring in "glowing" titles, oozing with sensation. What happened to normal discussions? Sensation is worshiped, rating is the important and general public is lost in the mighty sensational "WWEesh" fights between us doctors. Yes, 80% and more will have prostatic carcinoma at PM over certain ages. And you don't need to treat them all. But... again but, you do need to treat some. And until you bring me something that will differentiate each individual from another in a manner of "who has disease that needs to be diagnosed and treated and who doesn't" I rather diagnose more, watch more than diagnose less. And another thing: early diagnosis does not equal aggressive early treatment in all instances.But is does equal knowing about the condition, watching it and closely monitoring it and if needed or justified treating it.
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Re: Does early diagnosis really save lives?
posted at 23/6/2012 5:12 AM BST
on bmj.com
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Posts: 1280
First: 9/12/2011 Last: 14/5/2013 |
Of course it is saving lives, early detection is a must. DuaneF In Response to Does early diagnosis really save lives?: Des Spence writes in the BMJ this week that "early diagnosis is simply screening rebranded." http://www.bmj.com/content/344/bmj.e4252 "Big pharma loves early diagnosis: it makes more patients who take more profitable drugs for their whole life. The other certain outcomes of early diagnosis are more testing, more referrals, and more interventions. In turn, these generate more non-progressive disease, “incidentalomas,” and overdiagnosis—impaling anxious patients with yet more fear and non-disease pathology, while the medical fatalists happily ignore all warnings. The thoughtless and emotional language of “early diagnosis” is in reality just bad screening and the worst science." Is this obsession about early diagnosis really saving many more lives? Or is it turning us all into patients? Posted by mbillingsley |
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Re: Does early diagnosis really save lives?
posted at 23/6/2012 5:14 AM BST
on bmj.com
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Posts: 1280
First: 9/12/2011 Last: 14/5/2013 |
John, your Joking right? You do not believe early detection saves lives? Early detection is paramount. No Doctor worth anything would want later detection! This is a no brainer! DuaneF In Response to Re: Does early diagnosis really save lives?: Duane, Yoram, Please read the NS article. Good clinicians and researchers are questioning that, and as I said above, what is the point of pursuing earlier and earlier diagnosis of, say, prosatatic carcinoma? 80% of men over 80 have prostatic carcinoma in situ, yet they mostly die of something else. I can't say how relevant that is to breats or colonic CIS. The question is not , "Is cancer best treated early?" but "WHICH cancers need early detetction and treatment?" JOhn Posted by John D |
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Re: Does early diagnosis really save lives?
posted at 23/6/2012 6:10 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Dear Colleagues: This is indeed a quite important and interesting discussion. To begin with we need to differentiate what kind of treatment and diseases we are talking about.... - Life Style treatment? - Drug Treatment? - Surgical Treatment? - Coronary Stent Treatment? Of course there is (in my humble opinion) an abusive prescription of drugs (eg: statins) based on early check-up labs. As physicians we are becoming more and more slaves of images or lab tests.... and also of defensive medicine....And all that have costs for patients, physicians, and healthcare systems.... I have read Des Spence article. And I do not think he is all that wrong. But this is not a simple point, and it is in the core of our medical profession nowadays. All Best, Joey
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