I greatly admire the work you are doing, but I would push back on this one on several key points. For one thing you mainly interview doctors, and not one of them has identified a key problem which is they often have a profit motive for using testing results to convince patients to undertake procedures they might not normally need. To cite the most obvious example, PSA testing for men, which was opposed by the American Cancer Society until quite recently on the grounds that they often have side effects that are quite damaging such as incontinence. A study was done comparing Britain, where annual PSA tests are still discouraged and Sweden, where they are obligatory. The study found a far higher death rate from prostate cancer in the UK than in Sweden. Your Harvard doctor also claimed that testing can lead to results that seem abnormal when compared to the general population. That's because lazy doctors look only at reports from the two main commercial labs that use, as he said, two standard deviations from the mean to determine what is healthy. But the point should be frequent testing will allow you and your doctor to detect when your own results deviate from your baseline and could point to a problem. To your point about seeking second and third opinions and how they can be lethal, I disagree completely, as long as those opinions are solicited in a reasonable time frame, unlike your tech CEO who took months. When contemplating major surgery (apart from acute events) it is essential to confirm a doctor is acting in your best interests and not in their own financial interest in proposing treatment. To go back to the prostate example, a urologist will invariably recommend a 16-point needle biopsy to any male presenting with a sharp increase in PSA score. That's how they make money. But another doctor might tell you that a more conservative approach, involving PSA retesting, or using a more robust blood test such as the 4K score or EpiSwitchPSe or pelvic MRI can better determine the liklihood of cancer without any side effects. The fact is there are numerous causes of a high PSA, including recent sex activity, recent exercise, inflammation from an illness or antibiotic use, so the resort to an immediate biopsy is uncalled for, but urologists will rarely tell you to tread softly. That's why it's crucial to have your own PSA history, rather than let a doctor compare your result to the population at large. I have many more examples of why testing is essential and not as danderous as you propose and why a 2nd opinion is important.
Great article. It’s a bigger problem in the US, where medicine is a highly entrepreneurial industry, with limited government oversight, creating enormous opportunities for snake oil vendors of every description to separate consumers from the money.
I am not necessarily arguing for more government control. But US residents should think twice about subjecting themselves to all the testing on offer. To put it cynically, it makes you a mark for somebody’s grift.
I greatly admire the work you are doing, but I would push back on this one on several key points. For one thing you mainly interview doctors, and not one of them has identified a key problem which is they often have a profit motive for using testing results to convince patients to undertake procedures they might not normally need. To cite the most obvious example, PSA testing for men, which was opposed by the American Cancer Society until quite recently on the grounds that they often have side effects that are quite damaging such as incontinence. A study was done comparing Britain, where annual PSA tests are still discouraged and Sweden, where they are obligatory. The study found a far higher death rate from prostate cancer in the UK than in Sweden. Your Harvard doctor also claimed that testing can lead to results that seem abnormal when compared to the general population. That's because lazy doctors look only at reports from the two main commercial labs that use, as he said, two standard deviations from the mean to determine what is healthy. But the point should be frequent testing will allow you and your doctor to detect when your own results deviate from your baseline and could point to a problem. To your point about seeking second and third opinions and how they can be lethal, I disagree completely, as long as those opinions are solicited in a reasonable time frame, unlike your tech CEO who took months. When contemplating major surgery (apart from acute events) it is essential to confirm a doctor is acting in your best interests and not in their own financial interest in proposing treatment. To go back to the prostate example, a urologist will invariably recommend a 16-point needle biopsy to any male presenting with a sharp increase in PSA score. That's how they make money. But another doctor might tell you that a more conservative approach, involving PSA retesting, or using a more robust blood test such as the 4K score or EpiSwitchPSe or pelvic MRI can better determine the liklihood of cancer without any side effects. The fact is there are numerous causes of a high PSA, including recent sex activity, recent exercise, inflammation from an illness or antibiotic use, so the resort to an immediate biopsy is uncalled for, but urologists will rarely tell you to tread softly. That's why it's crucial to have your own PSA history, rather than let a doctor compare your result to the population at large. I have many more examples of why testing is essential and not as danderous as you propose and why a 2nd opinion is important.
Very interesting. Well done!
Great article. It’s a bigger problem in the US, where medicine is a highly entrepreneurial industry, with limited government oversight, creating enormous opportunities for snake oil vendors of every description to separate consumers from the money.
I am not necessarily arguing for more government control. But US residents should think twice about subjecting themselves to all the testing on offer. To put it cynically, it makes you a mark for somebody’s grift.