Here’s a great editorial on informed consent in screening.
15 years ago, I always felt a bit alone when voicing my concerns about the way that medical screening tests were often oversold to patients, who weren’t often told of the problems and failings of testing, never mind the problems we could end up dealing with – which still may not have benefited that person. The first big piece I wrote on that was for the Life and Arts section of the FT, in 2004, and the drip-drip-drip of research showing that harms from screening exist have persisted since.
10 years ago, I was aware of other voices, perhaps not always confident in speaking out, but when you seem to be opposing the medical establishment, vocal ‘patient groups’ and the Department of Health, that’s maybe understandable.
In the last few years, though, there seems to be a much better heard, though still too distant voice, calling out for a bit more sense over medical screening. Rather than being treated as a disreputable fringe, the ‘sense’ movement seems to be persisting in building a steady counter to the constant cries for more screening tests and more often.
Still not good enough, though. The next crucial happenings to get fairer deals for patients need to be twofold. 1) The NHS needs to get it’s house in order, with cost effective appraisals for all screening programmes. And 2) private healthcare clinics offering non evidence based screening tests need to be dealt with properly, promptly, and with legislative force.
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There is another argument against screening (or at least against early treatment). Sometimes the best treatment option is “wait and see” – because there is a good chance that the cancer will develop slowly and treatment is pretty invasive. For example, with prostate cancer, wait and see is often a viable treatment option. The recent advances in genetics and molecular biology mean that the understanding and treatment of cancer is improving at a rapid rate – this adds weight to the “wait and see” option. If the cancer is developing slowly, then a new treatment of a more advanced cancer in five years time my offer better prognosis of than treating the cancer now.
Note that I’m not advocating “wait and see” as a general option, just saying that where currently “wait and see” is a viable option then its consideration could be given a bit more weight.
Great, I never knew this, thanks.