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The Fallacy of Catching It in Time

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The Obama administration is making a huge financial commitment to preventive care. But will it be targeted toward “early detection,” with its inherent risks, or will its focus be on true preventive care?

Primary care physician Kevin Pho gave the nation a wake-up call in a recent USA Today blog post. President Nixon advocated “fighting cancer with a check-up and a check.” Vice President Al Gore called for increased spending to “win the war on cancer.” Now President Obama has made the “largest investment ever in preventive care.” But Dr. Pho points out that “no screening test is foolproof or can guide doctor or patient with certainty on proper treatment. . . . For every inspiring story of a person cured from cancer made possible by early detection, there are untold stories of many more who suffer from the side effects of unnecessary invasive procedures stemming from false positive test results.”

In his book Should I Be Tested for Cancer? Maybe Not and Here’s Why, Gilbert Welch, MD, a professor of medicine at Dartmouth, wrote about the glaring lack of scientific evidence for routine mass screenings for such diseases as prostate cancer using the PSA blood test, breast cancer using mammography, and even colon cancer using colonoscopies. Dr. Welch says the science indicates that instead, there should be a careful evaluation of each individual’s lifestyle choices and family history to determine if early screening makes sense for the him or her.

Early detection has masqueraded as preventive medicine to the extent that doctors and patients alike don’t see the difference. One billion dollars of the economic stimulus package is supposed to be targeted for disease prevention and wellness programs—about one-third to be focused on immunizations, and the remaining on new programs to prevent chronic disease. The big question, however, is whether there will also be public education programs about lifestyle choices, which can actually make a meaningful difference in the rate of chronic disease in this country?
To date, public health efforts have been disappointing. Dr. Walter Willett of Harvard has demonstrated that lifestyle choices like eating good fat daily and no bad fat at all; eating more vegetables and fruits and, if grains are consumed, only whole grains; getting daily activity; and supplementing wisely could reduce the risk of heart disease by a stunning 83%, and the risk of type II diabetes by up to 90%. On the flip side, Avandia reduces the risk of type II diabetes a mere 47%—with risks that many researchers feel outweigh its benefits. Avandia gets the headlines. A good diet and exercise doesn’t.

Dr. Pho says it well: “Early screening tests are not always in the patient’s best interest. . . . As much as we’d like to believe that early detection automatically leads to better care, that is not always the case. There cannot be a one-size-fits-all approach. Persuasive arguments can be made for and against screening, and the decision is a highly personal one. But patients must be better informed of the potential consequences either choice can bring.”

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