Demystifying Medicine One Month at a Time

Tag: letters

From the Mailbag

Yes, we’re baaaa-aack. Here’s a letter from one of our readers:

Dear GlassHospital,

media hysteriaWhile I am a firm believer in the infallibility of doctors and modern medicine, I am desperately struggling with the Dallas handling of an Ebola patient. Sure, sometimes there’s that perfect storm of things gone wrong, opportunities missed, etc (think about the assassination story of Archduke Franz Ferdinand – seems it was destined to happen) but the spread of infectious diseases need not be history-making-world-changing-events in today’s “modern” era, should it? Is there that much of a divide between the knowledgeable and the uninformed – a gap that rivals our economic disparity? Is politics playing a role here, like [Texas Gov. Rick] Perry won’t allow any federal coordinated oversight/CDC management?

I used to watch silly action movies (“Whitehouse Down” for example) and think, “that would never happen! there’d never be such a dumb-ass breach of security like that!” Now I question if I’m the silly dumb-ass who believed there was a working system in place.

So tell me Dr. Glass: while I retain confidence in individuals and continue to hold doctors in high esteem, should I/can I trust hospitals?

Sincerely,

A Lost Patient

Mailbag

Dear Glass:

I loved your recent piece on unnecessary screening tests in the Atlantic.

“Letters! We’ve got letters!”

You explain things so simply and clearly. Kudos!

One question, though. I understand when you say in general that CT scans for lung cancer screening can be dangerous. Excess radiation exposure, incidentalomas, cost, etc. I get it. But for those occasions when someone gets a lung tumor discovered early, don’t you think the screening is actually worth it? I mean, how can finding cancer earlier NOT prolong life?

Sincerely,

Paula from Paducah

Good question. Two related answers.

The first is the concept of lead-time bias. [Look at figure 2 in the article linked here.]

Simply defined, lead-time bias gives a the false impression of prolonged life, because the time of diagnosis occurs earlier. But in diseases for which the treatment we have doesn’t alter the course of the illness (like lung cancer), we do not actually prolong life. So the “early” diagnosis is in fact an artifact.

Reason 2 is that lung cancer discovered on screening CTs is usually too far advanced to make early treatment meaningful in terms of survival benefit. Put another way, even if you know earlier that you have the illness, it doesn’t make a difference (in aggregate) for people with the disease.

This stuff is hard because if you’re the one (or you have a family member or friend) with the disease, it seems logical that it HAS to make a difference to find the information sooner rather than later.

Sadly, at this point, it’s just not true.

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