An Epidemic of Overtreatment

We all know about epidemics of infectious disease — that’s how the science of epidemiology got its name in the 19th century when the cause of cholera was first traced by statistics to a contaminated water well in London. But here’s what a modern epidemic looks like — this one not an epidemic of disease but an epidemic of overtreatment.

thyroid_cancer_mortality-thumb

The graph is from a new study about what happened when South Korea started free ultrasound testing for thyroid cancer in 1999. You can see how the incidence rate (detection) of the cancer skyrocketed.

A good thing, right? Wrong.

Because look at the dots crawling along the bottom of the graph: That’s the death rate from thyroid cancer in Korea — it’s the same before and after the explosion of detection and treatment. Which means all that extra medical care hasn’t done much, except to deliver more medical care.

The graph comes from a new study in the New England Journal of Medicine by a group of Dartmouth researchers who have been hawkeyes on wasteful medical practices.

Thyroid cancer is one of those cancers, like prostate, that many people die WITH but few die FROM. So the more you look for it, the more you find. And when you find a small cancer, most sensible patients don’t want to take a chance of waiting around to see if it gets big and ugly. They want it out — now! Problem is the surgery can paralyze the vocal cords, result in injury or death from anesthesia mishaps, and cause other complications.

The leader of the Dartmouth team, Gilbert Welch, MD, has an op-ed in the New York Times. He says given all the pros and cons, we need to be wary of free screening programs that can tell us more information than is healthy to know.

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