Comments on: "The best test isn’t necessarily the one that finds the most cancer" http://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html Tue, 14 Feb 2012 21:09:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73814 Anonymous Wed, 11 Apr 2007 12:08:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73814 Great article. Thinking isn't dead in medicine after all. Human beings consistently overestimate their ability to predict and control events--Americans most of all. Therefore, if someone gets a terminal disease, we blame them or look for someone else to blame, who we believe could have prevented it.<br/><br/>This puts us on a frantic escalation of health costs seeking to guarantee ourselves a long life--fruitlessly. Great article. Thinking isn’t dead in medicine after all. Human beings consistently overestimate their ability to predict and control events–Americans most of all. Therefore, if someone gets a terminal disease, we blame them or look for someone else to blame, who we believe could have prevented it.

This puts us on a frantic escalation of health costs seeking to guarantee ourselves a long life–fruitlessly.

]]> By: Gasmanhttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73799 Gasman Tue, 10 Apr 2007 20:34:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73799 Unfortunately the power of <i>a priori </i>logic will crumble under the effect of hindsight bias and regret. People, no matter how well informed beforehand, once diagnosed with cancer will regret that they did not get the more sensitive and more frequent testing. One manefestation of that regret is to seek counseling from the legal profession with the ultimate effect on the medical world. The ideal focus is on keeping individuals as healthy as possible, which requires not doing everything possible. The legal refocus medicine on doing the most possible, even if this has no marginal benefit, or even proves to be a detriment. Unfortunately the power of a priori logic will crumble under the effect of hindsight bias and regret. People, no matter how well informed beforehand, once diagnosed with cancer will regret that they did not get the more sensitive and more frequent testing. One manefestation of that regret is to seek counseling from the legal profession with the ultimate effect on the medical world. The ideal focus is on keeping individuals as healthy as possible, which requires not doing everything possible. The legal refocus medicine on doing the most possible, even if this has no marginal benefit, or even proves to be a detriment.

]]> By: Happymanhttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73796 Happyman Tue, 10 Apr 2007 18:51:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73796 brilliant. I too will post this in my office.<br/><br/>experts on tv need to be qualified by real experts before espousing the virtues of any test or procedure, as the lay public isn't equipped to critically evaluate the information coming from an unknown with a white coat & stethoscope, and the term "doctor" is very loosely applied today. brilliant. I too will post this in my office.

experts on tv need to be qualified by real experts before espousing the virtues of any test or procedure, as the lay public isn’t equipped to critically evaluate the information coming from an unknown with a white coat & stethoscope, and the term “doctor” is very loosely applied today.

]]> By: Diorahttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73794 Diora Tue, 10 Apr 2007 17:54:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73794 Anon at 12:40, I was about to post the same thing about the authors, but you beat me to it.<br/><br/>These are pretty well-known names. They are doctors and professors at Dartmouth Medical School. Dr H Gilbert Welch wrote a number of papers on the subject including the one mentioned in Orac's posts recently. He also wrote book "Should I be tested for cancer" which talks about benefits and risks of screening in a manner that is easily understood by any reader. He also explains there why doctors are pushed to test including a story about his friend who was sued for not ordering a PSA test (not sure if it is the same as Merenstein becuase the book doesn't mention names).<br/><br/>I wouldn't blame people though for believing in earlier (and earlier) detection. As long as they hear "experts" in the media recommending more and more tests they are going to believe in it. The only way to change public perception is to have more articles like this one in the media. Anon at 12:40, I was about to post the same thing about the authors, but you beat me to it.

These are pretty well-known names. They are doctors and professors at Dartmouth Medical School. Dr H Gilbert Welch wrote a number of papers on the subject including the one mentioned in Orac’s posts recently. He also wrote book “Should I be tested for cancer” which talks about benefits and risks of screening in a manner that is easily understood by any reader. He also explains there why doctors are pushed to test including a story about his friend who was sued for not ordering a PSA test (not sure if it is the same as Merenstein becuase the book doesn’t mention names).

I wouldn’t blame people though for believing in earlier (and earlier) detection. As long as they hear “experts” in the media recommending more and more tests they are going to believe in it. The only way to change public perception is to have more articles like this one in the media.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73793 Anonymous Tue, 10 Apr 2007 17:40:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73793 Although this was published in the lay press, it is not written by laypersons. The tagline at the end says the authors are physician researchers with the VA Outcomes Group and on the medical faculty at Dartmouth.<br/><br/>It's a really good commentary though.<br/><br/>We the public have had the mantra of screening and early detection remorselessly drummed into us. <br/><br/>The truth is that tumor biology is probably the biggest determining factor in cancer survival. And who ends up with the most favorable tumor biology is, as far as anyone can tell at this point, a complete crapshoot.<br/><br/>No one wants to hear that, though. People would rather feel they are in control, hence they will continue to conflate screening and prevention. They will continue to believe that more tests equals better early detection and lower mortality.<br/><br/>Sigh. Although this was published in the lay press, it is not written by laypersons. The tagline at the end says the authors are physician researchers with the VA Outcomes Group and on the medical faculty at Dartmouth.

It’s a really good commentary though.

We the public have had the mantra of screening and early detection remorselessly drummed into us.

The truth is that tumor biology is probably the biggest determining factor in cancer survival. And who ends up with the most favorable tumor biology is, as far as anyone can tell at this point, a complete crapshoot.

No one wants to hear that, though. People would rather feel they are in control, hence they will continue to conflate screening and prevention. They will continue to believe that more tests equals better early detection and lower mortality.

Sigh.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/04/best-test-isnt-necessarily-one-that.html#comment-73792 Anonymous Tue, 10 Apr 2007 17:34:00 +0000 http://clients.emmense.com/kevinmd/2007/04/the-best-test-isnt-necessarily-the-one-that-finds-the-most-cancer.html#comment-73792 Wow- what a great commentary. This is going to be copied and posted in all of my exam rooms. Wow- what a great commentary. This is going to be copied and posted in all of my exam rooms.

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