I generally support the guidelines in the USPSTF, and they are fairly conservative. However, convincing the public that less screening is better is a tough sell. All it takes is one media-hyped “missed diagnosis” story to undo all the evidence that physicians try to teach.
So, I don’t think this guy will get very far with his views:
For adults, we can debate the Pap smear for women””not whether but how often. Aside from that, there’s no reason for any routine screening, including an annual physical examination. Go to the physician whenever you have a question””and wouldn’t it be nice if you had a physician who was rewarded for taking the time to answer?
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He won’t get far, but it isn’t because his views aren’t defensible-they are. It is because they are so out of synch with the zeitgeist.
If you read Hadler’s book, he makes a lot of sense. And he backs up his opinions with a careful analysis of currently available evidence and data. With health costs skyrocketing and Medicare going broke, I think he is a great candidate for the next Surgeon General.
I could see getting rid of the mammogram and PSA as screening tools, but cholesterol? I thought diseases like hyperlipidemia and hypertension were slow, silent killers that needed to be checked early and often and treated chronically. I had always been under the impression that Framingham had taught us that much.
I thought diseases like hyperlipidemia and hypertension were slow, silent killers that needed to be checked early and often and treated chronically. I had always been under the impression that Framingham had taught us that much.
Did he? Correlation isn’t causation. So cholesterol correlates somewhat with heart deases. Maybe something else causes both. Most of the evidence for statins came from very high risk males, some with heart desease. It is also totally unclear if statins work by reducing cholesterol or by reducing inflammation. If someone doesn’t yet have heart desease, the evidence that statins would prevent it is far from clear.
There is very little evidence, if any, for statins for primary prevention, certainly not in women. Yet there are millions of middle aged healthy women on statins, and they suffer sometimes from side effects because they have doctors who says to them “what would you rather have a heart attack or leg pain?”. Since the doctor in question usually forgets to mention NNT, poor women are under impression that they are actually sick and are in imminent danger of a heart attack.
As someone who has to do medication reconcillation in an ER every day, I can tell you that the whole world is on lipitor. Younger and younger people are being put on so many medications. Will they live longer? Will they have an increased quality of life? Somehow I doubt it.
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