Comments on: The media and their pro-screening bias http://www.kevinmd.com/blog/2007/05/media-and-their-pro-screening-bias.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Diora http://www.kevinmd.com/blog/2007/05/media-and-their-pro-screening-bias.html/comment-page-1#comment-75171 Diora Thu, 17 May 2007 13:49:00 +0000 http://clients.emmense.com/kevinmd/2007/05/the-media-and-their-pro-screening-bias.html#comment-75171 I am not sure these risks are "unquantifiable". The rate of false positives for many tests is known, the additional tests performed after false positives are known, the risk of these tests is known as well. So the risks are very quantifiable. Similarly, the radiation risk of CT scans is known as well. A lot more of your patients would be willing to ignore vague unquantifiable risk of anguish then "about 50% chance of at least one false positive after 10 yearly screens" for example. <br/><br/>Also, I don't understand why neither Kevin nor dl mentions overdiagnosis as one of the risks of some of the tests. I'd imagine to many people the possibility of suffering serious life-threatening side-effects would look more serious that a potential for anguish. Of course, this can be expressed not in vague "potential" terms but in clear "your risk of being diagnosed with this desease is higher if you get screened". <br/><br/>I do agree with dl that people should be able to decide for themselves. But they should decide based on accurate information. I find the fact that neither Kevin nor dl even mentioned overdiagnosis as a possible risk a bit strange.<br/><br/>As far as the media is concerned - journalists are patients themselves and they've been subjected to the same endless promotion of screening for years. If you want to blame somebody for media bias blame "TV doctors", not journalists. I am not sure these risks are “unquantifiable”. The rate of false positives for many tests is known, the additional tests performed after false positives are known, the risk of these tests is known as well. So the risks are very quantifiable. Similarly, the radiation risk of CT scans is known as well. A lot more of your patients would be willing to ignore vague unquantifiable risk of anguish then “about 50% chance of at least one false positive after 10 yearly screens” for example.

Also, I don’t understand why neither Kevin nor dl mentions overdiagnosis as one of the risks of some of the tests. I’d imagine to many people the possibility of suffering serious life-threatening side-effects would look more serious that a potential for anguish. Of course, this can be expressed not in vague “potential” terms but in clear “your risk of being diagnosed with this desease is higher if you get screened”.

I do agree with dl that people should be able to decide for themselves. But they should decide based on accurate information. I find the fact that neither Kevin nor dl even mentioned overdiagnosis as a possible risk a bit strange.

As far as the media is concerned – journalists are patients themselves and they’ve been subjected to the same endless promotion of screening for years. If you want to blame somebody for media bias blame “TV doctors”, not journalists.

]]> By: DL http://www.kevinmd.com/blog/2007/05/media-and-their-pro-screening-bias.html/comment-page-1#comment-75152 DL Thu, 17 May 2007 00:42:00 +0000 http://clients.emmense.com/kevinmd/2007/05/the-media-and-their-pro-screening-bias.html#comment-75152 What if, after explaining everything to a patient about screening tests - the concepts of false-positives/negatives, possibilities of further testing and potential complications, etc, and the patient STILL wants the test? Is it acceptable to order it? It seems to me that we are arguing that the patient accept our arguments about unquantifiable risks (potential for anguish, potential for further testing and potential complications, potential false security, etc) for the potential risk of missing something that the patient might really have. In other words, the value to the patient of having an answer, even if it's a qualified one, is worth more to them than the potential enumerated risks. Why can't they decide this for themselves?<br/>Great site, by the way. Thanks for putting it together! What if, after explaining everything to a patient about screening tests – the concepts of false-positives/negatives, possibilities of further testing and potential complications, etc, and the patient STILL wants the test? Is it acceptable to order it? It seems to me that we are arguing that the patient accept our arguments about unquantifiable risks (potential for anguish, potential for further testing and potential complications, potential false security, etc) for the potential risk of missing something that the patient might really have. In other words, the value to the patient of having an answer, even if it’s a qualified one, is worth more to them than the potential enumerated risks. Why can’t they decide this for themselves?
Great site, by the way. Thanks for putting it together!

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