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Healthy Skepticism Library item: 20591

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Electronic Source

Schwitzer G
When doctors don’t discuss harms of screening tests with patients
Health New Review.org 2013 Oct 22
http://www.healthnewsreview.org/2013/10/when-doctors-dont-discuss-harms-of-screening-tests-with-patients/


Full text:

Another important paper in the JAMA Internal Medicine “Less is More” series.

“Overdiagnosis and Overtreatment: Evaluation of What Physicians Tell Their Patients About Screening Harms,” is by one of my risk communication gurus, Gerd Gigerenzer and colleague Odette Wegwarth. They surveyed 317 US men and women aged 50-69 years, a population with the highest exposure to screening programs.

Their summary:

Most participants in our sample who underwent routine cancer screening reported that their physicians did not tell them about overdiagnosis and overtreatment. The few who received information about overtreatment had unrealistic beliefs about the extent of that risk. The large number of uninformed patients might be explained by a large number of physicians who themselves know little about screening harms. When a national sample of 412 US primary care physicians, part of a larger project on physicians’ understanding of cancer screening statistics,was asked about the extent of overdiagnosis for mammography screening and PSA testing; only 33.9% and 42.9%, respectively, were able to provide a correct estimate.

The results of the present study indicate that physicians’ counseling on screening does not meet patients’ standards. Most individuals desired information about screening harms, which was not given, and attested that this knowledge would matter to them: 69% of the sample indicated that they would not start screening if overdiagnosis was as high (ie, ≥10 cases per 1 life saved) as it is in mammography and PSA testing.

Our results should prompt medical educators to improve the quality of teaching about screening and encourage medical journal editors to enforce clear reporting about overtreatment when publishing results on the effectiveness of cancer screening. These means may not be sufficient but would be a first step toward enhancing the number of physicians and patients who thoroughly understand the potential consequences of taking a cancer screening test.

Gigerenzer’s work consistently demonstrates the trickle-down effect of how we end up with a poor public dialogue about screening tests. Many physicians don’t get it right. They may turn to published papers in journals that overestimate the effectiveness of screening. And so communication with patients suffers.

And, as we consistently point out, many media messages – in journalism, advertising, marketing and public relations – lead to even worse public understanding. Here’s a Reuters Health story on the paper – one of the only mainstream news stories we saw on it.

Here are some things we’ve published in the past about Gigerenzer’s work:

Risk comm guru Gigerenzer argues that absolute risk communication is a moral issue
Five year survival rates can mislead – message to medical educators, medical journals, journalists and the public
More evidence of how patients overestimate benefit of screening
What Doctors Don’t Know & Journalists Don’t Convey About Screening May Harm Patients
When patients become pitchwomen: The duty of the medical journalist

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909