The Myth of Early Detection – Evidence Based Medicine?

One of the key questions raised about treatments that differ from mainstream medicine is "what is the evidence that it is safe and effective?" A very valid question indeed. Clearly it is imperative that we learn what works and what doesn’t. But, it is not quite that simple. Some approaches work for some people and not for others and it is the experience and skill of the clinician to make the right match between a patient’s condition and the best clinical approach. In other words, the clinician must practice the art of medicine.

In recent days, several studies have been released that bring back into the spotlight the questionable validity of the assumption that early detection of a disease and the screening required to make this detection is the gold standard of quality medical practice. The two screenings for early detection that are most common are PSA for prostate cancer and mammography for breast cancer. Indeed medical practices are measured and rewarded based on achieving high percentages of their patient populations getting such tests. The higher the percentage screened the more "pay for performance" dollars flow to the practice. The economic incentives trump clinical value. The authors of these studies argue that the public is not currently presented with a balanced view of the screening, with potential benefits overemphasized and potential harms rarely discussed.

The conclusions of these studies have shaken conventional medical thinking. It makes me think of the old adage "half of what is learned in medical school is wrong, the only problem is figuring out which half".

Unfortunately, the recent studies do not provide much guidance to patients and their physicians other than to provide a balanced view. I suspect that most patients are not going to say "thanks for information doc, I will do more research and analyze what I find and get back to you with my decision". They are more likely to say "so what do you recommend that I do?" The response in all likelihood, despite conflicting evidence, is that the patient should go ahead with the screening. Why, because of fear of a malpractice charge for missing a cancer diagnosis and the economic incentives mentioned above.

The bigger issue than these specific study findings is what else do we take as absolute truth in medicine that is wrong? In discussing this issue with John Bordiuk, one of the Marino Center doctors, he said the only "absolute" truths in preventing illness and maintaining wellness is eat a proper diet, get a decent amount of exercise, get adequate sleep, and control stress levels. This is more powerful in protecting health than any screening tests we know. Not very high tech but it works a majority of the time for most people.