I have always been very skeptical of the idea of “overdiagnosis”. Now, overtreatment is a real problem. And I suppose you could have a problem wherein, once you reveal to a patient that they have a tumor, they’re going to want it treated regardless of what the statistics say.
But it sounds to me like the real problem is not patients at all, but doctors who insist on treatment because they don’t understand statistics.
“[O]nce a woman is diagnosed, it’s hard to say treatment is not necessary.” Well, maybe you need to try harder.
Good luck selling the “watch and wait” approach to scared patients who have heard they have (buzzword alarm) “CANCER”. Explaining to all their social circle why they ignore the “CANCER” in their body. Psychology is a big factor here.
Even educated patients who know their probability theory will often be plagued of thoughts of “What is my cancer doing right now? Is it growing? Should I really ignore it? It’s in my body!” Often times in such cases the (unnecessary) treatment buys you peace of mind, at great cost. It’s much more rational to forego the test if you know you’d rather not treat, than expose yourself to (typically) such immense mental duress.
There is a simple solution to this problem: don’t call it cancer. I think the name DCIS exists for partly for this reason, although the C standing for carcinoma isn’t helping. There are many specific proposals for certain grades of cancer to be called hyperplasia or adenoma, entirely for this reason, but I don’t think they’ve caught on.
Not like MMS, but more like homeopathy. Something along the lines of
“This kind of tumor might be cancerous, or it might not be. There’s no way to tell right now. We could treat it aggressively, but that has a n% chance of major side effects without doing much good. We would like to test the effectiveness of natural herbal treatments [or other buzzwords] on early-stage tumors like this one. Drink this type of tea up to four times a day [or take this pill], record when and how often you drink it, and come back for regular screening.”
And afterwards “Honestly, there is no way of knowing if that was a benign mass or if the experimental treatment made a difference. We will take your information and use them to determine if there is a statistically significant difference between people based on their use. Based on preliminary information, there is no reason to believe that this treatment is effective, but there is still more data to be gathered.” OR “Well, the experimental treatment has failed, but because of the close monitoring we can still begin the conventional treatment in the early stages of development, where they are most effective.”
I’m not sure if prescribing placebo when placebo is indicated is a dark art or not...
Homeopathy is probably a more effective placebo than both mineal supplements and astrology.
Homeopathy has the feature that you have an authorative human being who really listens to the patient when he describes his various symptoms. Than the authorative human being decides on a particular sugar pill that the patient usually has to take multiple times per day.
If you want a placebo with minimal sideeffects homeopathy is a good pick.
But why minimal side effects? You should look to maximize positive sideeffects. Send the person to a well trained psychologist who encourages good lifestyle changes.
Quit smoking. Exercise more. Eat more greens.
There may be pressure on doctors to overtreat if, in terms of possible litigation, the expected outcome for the doctor of overtreatment is better than the expected outcome for undertreatment.
I have always been very skeptical of the idea of “overdiagnosis”. Now, overtreatment is a real problem. And I suppose you could have a problem wherein, once you reveal to a patient that they have a tumor, they’re going to want it treated regardless of what the statistics say.
But it sounds to me like the real problem is not patients at all, but doctors who insist on treatment because they don’t understand statistics.
“[O]nce a woman is diagnosed, it’s hard to say treatment is not necessary.” Well, maybe you need to try harder.
Good luck selling the “watch and wait” approach to scared patients who have heard they have (buzzword alarm) “CANCER”. Explaining to all their social circle why they ignore the “CANCER” in their body. Psychology is a big factor here.
Even educated patients who know their probability theory will often be plagued of thoughts of “What is my cancer doing right now? Is it growing? Should I really ignore it? It’s in my body!” Often times in such cases the (unnecessary) treatment buys you peace of mind, at great cost. It’s much more rational to forego the test if you know you’d rather not treat, than expose yourself to (typically) such immense mental duress.
There is a simple solution to this problem: don’t call it cancer. I think the name DCIS exists for partly for this reason, although the C standing for carcinoma isn’t helping. There are many specific proposals for certain grades of cancer to be called hyperplasia or adenoma, entirely for this reason, but I don’t think they’ve caught on.
So, what we really need is a great placebo treatment with minimal side effects?
Something like Miracle Mineral Supplements? Homeopathy? Or something astrology-based?
Not like MMS, but more like homeopathy. Something along the lines of
“This kind of tumor might be cancerous, or it might not be. There’s no way to tell right now. We could treat it aggressively, but that has a n% chance of major side effects without doing much good. We would like to test the effectiveness of natural herbal treatments [or other buzzwords] on early-stage tumors like this one. Drink this type of tea up to four times a day [or take this pill], record when and how often you drink it, and come back for regular screening.”
And afterwards “Honestly, there is no way of knowing if that was a benign mass or if the experimental treatment made a difference. We will take your information and use them to determine if there is a statistically significant difference between people based on their use. Based on preliminary information, there is no reason to believe that this treatment is effective, but there is still more data to be gathered.” OR “Well, the experimental treatment has failed, but because of the close monitoring we can still begin the conventional treatment in the early stages of development, where they are most effective.”
I’m not sure if prescribing placebo when placebo is indicated is a dark art or not...
Homeopathy is probably a more effective placebo than both mineal supplements and astrology. Homeopathy has the feature that you have an authorative human being who really listens to the patient when he describes his various symptoms. Than the authorative human being decides on a particular sugar pill that the patient usually has to take multiple times per day.
If you want a placebo with minimal sideeffects homeopathy is a good pick.
But why minimal side effects? You should look to maximize positive sideeffects. Send the person to a well trained psychologist who encourages good lifestyle changes. Quit smoking. Exercise more. Eat more greens.
Blurgh! :-)
Yes, when the doctor knows for sure that a more radical treatment is counter-indicated. Which is the crux of the problem.
There may be pressure on doctors to overtreat if, in terms of possible litigation, the expected outcome for the doctor of overtreatment is better than the expected outcome for undertreatment.
Not only possible litigation. Overtreatment makes money for the hospital.