Pasco Phronesis

Muddling Through Science and Technology Policy

You Don’t Have To Be A President To Get Procedures You Don’t Need

While not explicitly so, this Bloomberg article by Virginia Postrel speaks to the same issues raised by former President George W. Bush’s recent heart procedure.  That Postrel is talking about cancer makes little difference when the questions come down to whether or not to operate.

While our understanding of cancer has changed, and our ability to detect many of them has improved, our reactions to diagnoses have not really kept pace.  No longer is every cancer a diagnosis a death sentence, because we now understand that not every cancer is necessarily fatal.  But nobody is described as ‘living with cancer’ so much as beating it or being a ‘survivor.’  Postrel notes a recent article from the Journal of the American Medical Association that demonstrates that not all early detection is productive:

“Optimal screening frequency depends on the cancer’s growth rate. If a cancer is fast growing, screening is rarely effective. If a cancer is slow growing but progressive, with a long latency and a precancerous lesion (eg, colonic polyps or cervical intraepithelial neoplasia), screening is ideal and less frequent screening (eg, 10 years for colonoscopy) may be effective. In the case of an indolent tumor, detection is potentially harmful because it can result in overtreatment. These observations provide an opportunity to refocus screening on reducing disease morbidity and mortality and lower the burden of cancer screening and treatments.”

So, if a screening detects a cancer, that is the start and not the end of determining what to do.  Regrettably the cancer advocates have yet to adapt their strategies to better reflect the diversity of this disease.  Continue reading

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