Is screening a dangerous marketing trick for your health?
There was an interesting article, some time ago, in The Atlantic, written by Oklahoma physician John Henning Schumann, which brings up the issue of over-screening—medical tests that simply are not necessary, or worse, detrimental. “General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short-term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial,” says the Cochrane Library.
I have been condemning routine screenings, especially cancer screenings, for decades. Many routine screening-detected ‘cancers’, in fact, are only incidentalomas which, if left alone or not detected in the first place, would have outlived the person. For example, the so-called ‘ductal carcinoma in situ’ in the breast is not a cancer at all.
Cancer screening is not only useless but downright dangerous. The best studies (these are studies done over 10-year durations in Canada, the US and Europe) have found that you have to screen 2,100 women every year for 11 years to prevent one death. So, to answer the question, ‘Is it lifesaving?’ Yes. One in 2,100 women would benefit from being screened over an 11-year period.
But, at the same time, of those 2,100 women, about 600 to 700 will have a false-positive. They will find something unusual or something abnormal and that will require biopsies, open surgeries, mastectomies and psychological trauma wrote Alan Cassels of University of Victoria (BC) who has authored several books on screening. The best one, according to me, was: Seeking Sickness: Medical Screening and the Misguided Hunt for Diseases. This book is an encyclopaedia of the scam of screening.
Screening in apparently healthy people is encouraged mainly to make lots of money from post-screening activities. It is just another marketing trick and a potentially dangerous one at that.
One can have a cancer in his/her body and live a perfectly long and healthy life. The cancer literature in medical science which is funded by the industry is mostly wrong. John Ioannidis at Stanford found that most of those studies cannot be replicated independently. Of the hundreds of studies by John Ioannidis, most did not stand up to scrutiny. This applies especially to cancers and statin drugs for prevention.
I would end this by quoting Dr Andrew Oxman of the Norwegian Knowledge Centre for the Health Services in Oslo, who told Reuters: “There are lots of examples where things start to be used and have entered the market based on surrogate outcomes and then actually proved harmful.” He mentioned the heart rhythm drugs encainide and flecainide which, for many years, were given to people with acute heart attacks. But trials showed they were actually bad for these patients.
“These drugs were given by well-meaning clinicians, but they actually killed more people than the Vietnam War did,” Oxman said. I still remember the days when I was senior registrar in cardiology at The Middlesex Hospital, London, where the protocol in the CCU was to give all these drugs one after another even if a couple of innocent premature beats are seen on the monitor in this order—Lignocaine, procainamide, encainide, flecainide. Most of these drugs were later shown to be killers!
I was once hauled up before an enquiry committee for not following the protocol in a healthy MP admitted one evening directly from the House of Commons where he felt ‘suffocated’. He was, of course, absolutely normal, as proved by later tests. He was grateful to me but I had to face a trial for dereliction of my duty in preference to my patient’s safety!
“When it comes to screening, a doctor who says ‘Let’s err on the side of caution,’ may actually err on the side of reckless ignorance and grave harm.” – Otis Webb Brawley
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)