The title of this post is identical to the title of a Feature Article by Wendy Glauser in the Feature section in the 7 April 2018 Issue of the New Scientist. H. Gilbert Welch is both a physician and an academic researcher. He has spend the last 25 years warning of the dangers of overzealous medicine. He fears that doctors are detecting problems too early convincing healthy people they are sick, and treating them too aggressively.
His latest research was published in December in the Journal of the American Medical Association. He found that in US hospital regions with high rates of CT scans, which are typically ordered to check the lungs and abdomen, many more kidneys are removed. Apparently when doctors look at the images they see the kidneys too, and often stumble on innocuous cancers. Welch said, “It’s leading some people to be treated for disease that was never going to bother them. Moreover, there is significant risk. 1 in 50 of those who underwent surgery died within a month.
Welch is a professor at the Dartmouth Geisel School of Medicine, He has written three books highlighting unnecessary medical care, as well as dozens of journal articles and call-to-arms pieces in newspapers such as The New York Times. With biomedical companies designing ever more tests, such as breath-tests for cancer, the problem seems poised to worsen. Welch says, “It’s a very frothy industry right now.”
Welch says, “I was taught in medical school that once a cancer was formed, it was going to relentlessly progress to metastatic cancer. We now know it’s a whole lot more complex than that.” Cancers can grow quickly and slowly; some even vanish on their own.
A new test the worries Welch is liquid biopsy, which identifies pieces of “cell-free DNA” in the blood to determine whether someone has cancer and how bad that cancer is. Welch says, “You think, how could you possibly argue with that, until you look under the hood.” We all have cell-free DNA in our blood, and liquid biopsy analyzes about 2000 different mutations in this DNA. An algorithm then determines what thresholds and combinations of mutation equal cancer. Welch worries about a future in which people are told: “You have a positive liquid biopsy, but we don’t know where the tumor is, so we’re gonna have to start looking.”
Richard Baker a radiologist and colleague of Welch’s says the he often dissuades his patients from a biopsy on their thyroids after imaging has found a nodule, even though that is why they’re seeing him. Baker says, “Thyroid biopsies are skyrocketing in this country, yet deaths from thyroid cancer have always been rare in the US and treatment carries risks of its own. These are difficult ideas for both patients and physicians to accept.
Regarding mammography he found that looking at women who were screened every year for a decade from the age of 50, he found that for every 1000 of these women, roughly one will avoid death through breast cancer, more than 500 will have at least one false alarm and 10 will be treated needlessly.
Welch asks if people want medical care as a way to deal with acute problems for things that are bothering them? Or do they want to take the power of medicine to look hard to try to find things wrong with them? In this age of super-sensitive diagnostics, seek and ye shall find.
For more information on this topic go to the healthy memory blog post, “Less Medicine, More Health.” Better yet, read the book by Dr. H. Gilbert Welch, “Less Medicine, More Health.”
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