DRUG BUST Alan Cassels
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eek and ye shall find. We can find disease wherever we look; the question is do we need to be looking? One of the longest-running debates in health care circles involves the dichotomy of “prevention” versus “treatment.” Some people complain that our “health” system has nothing to do with health and basically exists to patch you up once you’re broken. It’s a system that, by design, ignores many of the factors that make us sick in the first place. Many people praise the need for prevention using very compelling arguments, stressing that the bucks need to go towards health promotion and disease prevention in order to save further billions on medical services down the road. This would avoid much needless suffering and engender a healthier, happier society at a fraction of the cost we currently incur. There’s no doubt that, as a society, we need to do a better job of following the classic triumvirate of health promotion advice: Eat well. Exercise often. Don’t smoke. However, that which passes for prevention is often an exercise in consumerism to get us to part with even
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SEPTEMBER 2008
Medical scan scam more of our dollars. All in the name of health, of course. We’ve seen many examples of how “prevention” consumerism drives the use of pharmaceutical drugs prescribed to “prevent” all kinds of chronic disease, even when the evidence underlying those treatments really applies to only a small subset of “high risk” people who may benefit. The incessant drumbeat of preventative pharmacology persistently fails to remind us that many of those treatments provide infinitesimally small benefits for relatively healthy people at great costs with unknown risks. The pharmaceutical industry is not alone in discovering that prevention sells. Others, particularly those that market organ screening with some of the highest tech tools on the planet, such as the CT (computed tomography) or PET (positron emission tomography) scanning machines, have discovered that screening for disease is a cash cow capable of providing a much more lucrative revenue stream than that yielded by simply providing treatments for the sick. In fact, one way to sell “prevention” is
to establish a market for screening for the deadliest diseases lurking in your body – seeking out markers of disease, such as heart disease or cancer, before the disease can get you. This new generation of scanning devices wouldn’t look out of place in Dr. McCoy’s sickbay on the Starship Enterprise. These space-age devices generate three-dimensional images of your body’s insides and, in terms of diagnosing what is wrong with you, a CT or PET scan might be the best medicine for you. But, at the same time, because these machines are so good at detecting tumours and arterial plaque, entrepreneurs would naturally reason that we should grow that market by expanding the machines’ uses to more and more healthy people. In fact, why not send the whole population to get “screened,” under the guise that it would (like most arguments for prevention) ultimately save the health system money? It’s not that simple. Population-wide screening of healthy people seems intuitively sound until you look a little closer and realize the costs and potential for harm are considerable, including, in this
HEALTH
case, the massive doses of radiation that some of the tests themselves deliver. What do we really know about the overall screening of the population using these devices? The answer is not much. And it provides no solace that even the screening paradigm about which we know the most – screening mammography for breast cancer – is no slam-dunk. Maryann Napoli, associate director of the Centre for Medical Consumers in Manhattan (www.medicalconsumers.org), has an in-depth consumer’s view of the controversies around mammography. In a recent interview, she shared some of the statistics with me: “For every 2,000 women who have mammography over the course of 10 years, one woman will have her life extended because she was saved from having or dying from breast cancer. Meanwhile, 10 more women will be diagnosed and treated for a cancer that they didn’t need to know about.” The fact is the more mammography screening you do, the more things you’ll find. And the more stuff you find, the more you will be driven to determine if the lumps are lethal, beginning a cascade
