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The Problems with Overdiagnosis : Sometimes leaping head-first into the twenty-first century is not necessarily a good thing.
Sometimes it's better to leave technology's super-advanced Matrix Reloaded toys to the laboratory and to the minds of sci-fi script writers rather than to the increasingly scary diagnostic armamentarium of your Large HMO: "Ah, yes, Ms. Unsuspecting Candidate for Over-Diagnosis, your routine lab results were fine and you appear to be healthy as as the proverbial horse, but why don't we dig a little deeper and see if we can find something evil lurking behind your gall bladder or in your brain or breast? We can't be too careful, can we? Heh Heh." Actually this scenario happened to me.I was 41 years old, and my Large HMO internist had given me the go-ahead for feeling good and confident about my health . Actually patting me on my bare knee in that over-bearing avuncular manner some male M.D.s have, he smiled and said, "You're the healthiest 41 year old I have seen in a long time. But, just to be on the safe side (Word of warning: Start wiggling those ick detector antennae when an M.D. says to you, 'just to be on the safe side') I want you to get a baseline mammogram." The late seventies was at the beginning of the trend of looking at well patients to find evidence of disease, so being the good compliant patient, confidant that there was nothing wrong with me and wanting to please my male M.D., I replied, "Sure, Dr. M., how soon can I do it."
To make an already long story shorter, I had the baseline mammogram. They found a very small suspicious something. I went into the Big City UCSF Cancer Clinic where they did an enhanced and magnified mammogram which corroborated the suspiciosity.
After this Dr. M. referred me to a surgeon, another Dr. M. who suggested a needle biopsy under general anesthesia which I numbly agreed to do. The Large HMO pathologist found a few cancer cells - the report read well differentiated non-lobular carcinoma which is now called ductal carcinoma in situ. I then sought a second opinion from a non-HMO older woman cancer surgeon who concurred and said I should probably have a radical mastectomy "just to be sure." That's not what I wanted to hear from a woman, my supposed ally, but this is yet another lesson I learned from my cancer experience: I now know that not all women doctors are necessarily sympathetic to other women.
So, here I was, a month after my seemingly innocuous baseline mammogram, on the operating table for "real " surgery where they did a fairly radical lumpectomy which cut cutaneous nerves and left me permanently numb to the touch in a dinner plate sized area over my right scapula and triceps area. The surgeon also took 9 lymph nodes leaving a permanent crater in my right armpit.
The best thing about this awful scenario is that I was node-negative which means that there was no metastasis anywhere. Soon after the surgery and after a callous intern literally ripped my breast drainage tube from my chest wall under my right arm, I met with an oncologist who recommended radiation and "preventive" chemotherapy. I actually had one visit with the radiation oncologist who perumptorily tattooed cute little black dots on my chest and what was left of my right breast marking me permanently for the direction of the 4900 X-ray rads I was to absorb into my chest wall and set me up for 6 weeks of 5 day per week treatments. The little black dots are still there - a constant reminder of how close I came. . .
At this point, my out of control surfboard crashed onto the shore, I yelled STOP! and I became afraid, very afraid - not of my supposed cancer but of the treatments. I stopped right then and there with the allopathic route, even signing a legal document absolving the Large HMO of any legal stuff concurring that I was no doubt insane( I was, like "whatever" at his point and who cares if they think I'm crazy. . .) because I refused to be treated in the way that Father Knows Best. As you can read in "About me" I went the natural healing route and have been blessed with success for the past many years.
I honestly think now that I became a pawn in the sin of overdiagnosis. Who's to say that this tiny 1 centimeter in situ malignancy would not have been absorbed by my healthy body? I believe that we have cancer cells in our bodies at all times and our job in this lifetime is to create a healthy milieu in which all these renegade cells are summarily gobbled up as part of our daily street sweep. Was my timing off? If I had waited for another couple of months to have my baseline mammogram, would my healthy body by then have absorbed the tiny cancer? Sometimes I think it is just better to leave things alone.
The New York Times Magazine, March 16, 2003 had a wonderful article entitled The Perils of Prevention. If you can find it, read it as it exposes the basic flaws of uber-prevention.
In short, there is a belief that catching any disease early and treating it - often aggressively - can make you live longer. This is not necessarily true as has been shown in many many trials with many many people: For example, there have been 7 different clinical trials conducted since the 1960's involving over 100,000 women in the United States, Canada and Europe regarding the efficacy of mammograms in saving lives and the end result of these trials is this: There is no clear evidence to suggest that mammography is saving lives.
Here we must make the important distinction between diagnosing disease and saving lives: For example, statin drugs do lower cholesterol levels quite well, but more and more trials are revealing that statin drugs do not necessarily prevent deaths from heart attacks. Ditto with mammograms which are terrific at revealing abnormailities in the breast, but in the long run do not necesarily save or extend lives. Prostate Specific Antigen (PSA) tests for prostate cancer in men are very sensitive in revealing abnormal cells in the prostate gland, but the resultant usually disfiguring and impotence/bowel incontinence causing surgery does not necessarily save or extend lives.
Then, for even more bah humbug, there is the full body CT Scan which I have heard - apocryphal or not, I don't know - has the radiation levels of 350 chest X-rays. Your local Gene-Wilder in-Young-Frankenstein- mall doctor would be happy to crank up his mega-machine and zap you with all this radiation if you but ask and fork over the cash - no presciption needed for this latest body insult.
Anyway, it seems that this full body CT Scan is revealing all sorts of suspicious stuff in its travels around your poor unsuspecting body: For example, the kidneys are notorious for contentedly housing benign lumps which the full body CT Scan spots as suspicious entities which need closer inspection (read: surgical proceedure) yet 85% of these kidney spots will turn out to be nothing at all.
The DEXA scan which is used routinely to "diagnose" osteoporosis has it's dark side as well. Did you ever wonder what god-like person makes up the numbers for what is normal and what is not? For example who decides what is normal bone and what is osteoporotic bone? Many years ago a panel of experts which I will call the DEXA-crats defined osteoporosis as any bone density which is just slightly below that of a 25 year old woman!
And the famous default word -osteopenia - is a word MADE-UP by the DEXA-crats meaning just a tiny bit of bone loss (no problem) apparently just a hair under that of a 25 year old woman - no big deal, but we should probably recommend Fosomax anyway. Be afraid, be very afraid: Some animal studies are now showing that the long-term use of bone-sparing drugs may actually cause the bones to become brittle and to break and "we are prescibing these drugs to women who might or might not suffer a fracture 15 or 20 years down the road. (Dr. Susan Love, NY Times Mag, 3/16/03)
Doppler screening for carotid artery blockage is also creating an explosion of arterial roto-rooting aka carotid endarterectomy: Two-thirds of carotid endarterectomeis are performed on people who HAVE NO SYMPTOMS. That means that about 100,000 Americans endured a proceedure that has high risk of permanent harm (blindness and stroke) and cost $15,000 a pop. Let's see that is 1.5 BILLION dollars. . .
Somewhere down the line, the word diagnostics became synonymous if not interchangeable with the word prevention. The two are not the same . Think about the meaning of the two words: According to my Random House/Unabridged 11 lb dictionary: To diagnose means "to determine the identity of an illness or disease by a medical examination" while to prevent means "to keep from occurring. See how different these two words are? I deal in prevention which is wholly dependent on what you eat, what you drink, how you think and how often you move in order to keep dis-comfort and outright dis-ease from occurring. Do you - a well-person - really want to have mammograms, or your PSA's, your Dopper screenings or your full-body CT scans?
"Belief in interventionist preventive medicine has ascended in lock step with the proliferation of diagnostic tests which allow doctors to detect signs of disease in people who have few or no symptoms." Aha. So here we have a financial imperative all mixed up with an increase in the use of all the new diagnostic machines that hospitals and M.D.s have to pay for. It all becomes rather sticky, doesn't it?
Endnote: I'm not going to give you any advice on whether or not to have wellness diagnostic testing. It's a thorny issue indeed. It's a difficult and subtle decision you must make for yourself. So listen to me, listen to them, read a lot and use your inner guidance. There are no right or wrong answers here.
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