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June 26, 2014

"Maybe we don't all need annual physicals"

I find this article rather remarkable. When I was a kid barely a day went by without a public-service announcement on TV exhorting people to know the seven warning signs of cancer and urging people who thought they had one to see a doctor ASAP. "Early detection" was absolutely vital, they said.

Now we have Dr. Michael Rothberg, director of the Cleveland Clinic Medicine Institute Center for Value-Based Care Research quoted as throwing virtually all such early detection in the trash: "You're very unlikely to have any serious diseases that haven't shown symptoms." And, of course, we've recently been advised that mammograms and PSA tests should probably be avoided.

If I were a cynic--perish the thought!--I'd suspect these recent developments might be related to 1) government now funds a significant percentage of American health care, and 2) government is broke. 

Comments

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Ted Craig

Wasn't early detection a lot of the justification for ACA?

PaulS

And if I were a cynic, I'd suspect, in addition, that the standard attitude of madly frenetic mass exhortation owes to:

1. The medical profession's group-habit of jumping to unwarranted conclusions and claiming that 13-12 committee votes on this or that treatment are the Word Of God handed down from Mount Sinai. Hence the Coffee Study of the Week. Hence the Lipitor Cycle - first they want to put it in the water supply (seriously), then later on it becomes a lawyer joke on digital-subcarrier TV for causing diabetes, rhabdomyolisis, and God knows what-all else.

2. The great utility of the above for vastly trumping up the number of "visits". Given how insurances (gov't and private) function nowadays, that's what doctors looking to get rich often need to do.

3. The Noble-Cause Corruption stemming from jumping to a vast array of statistically dubious conclusions, and in the process deluding oneself that one is God.

Nearly all medical "prevention" (excepting, e.g., a few of the older and highly effective vaccines such as for smallpox or polio) falls into the category of Credence Goods.

That is, no one can tell beforehand what will work, and no one can tell after the fact what did work. At best one can make dubious guesses about the mythical statistically average patient - guesses that are even more dubious when applied to a particular patient instead being used to characterize the statistical ensemble. It easily turns into a game of Jackass.

Thus, I see no useful solution for the issues raised.

Maybe the fact that the government lacks infinitely deep pockets will finally tamp down some of the vast overtreatment, with iatrogenic illness a major source of mortality. One can only hope.

Sure, it's a heckuva way to go about it - but with statistical significance (does the "prevention" really do much or are we just kidding ourselves) and ethics (maybe there's a 51% chance that it saves one in a million - but is it killing 50, which is the type of problem that readily arises with "screening"?) having been tossed out the window decades ago, what's left?

By the way, I can remember when "publishing in the newspaper" was considered a serious sin among researchers. Now (in digital form) it seems to be completely normal. It seems to be entirely about shilling for renown funding.

PaulS

Oh, I was forgetting. About the Lipitor Cycle - when it has gone south, you simply shift a hydroxyl group from here to there, then rinse and repeat with the patent clock restarted.

dave smith

Curious. For the first time this year, all employees of Texas A&M system must have an annual physical or pay an extra 30/month.

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