The practice of screening healthy people for conditions before they have symptoms has gone out of control, according to Dr. H. Gilbert Welch. In an op-ed in today s New York Times, Dr. Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, makes a controversial proposal: We would all be better off, he says, if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be. In other words, doctors should stop focusing on giving healthy patients people without health complaints tests for all sorts of potential ailments, and instead target those who actually have symptoms.
This op-ed comes at a time when we ve been seeing a wide variety of sometimes contradictory and confusing evidence regarding whether certain types of screening are helpful or harmful. We ve heard that mammograms searching for early breast cancer and PSA (prostate-specific antigen) tests for prostate cancer are conducted too frequently, and that they too often lead to unnecessary surgery and the resulting complications. On the other hand, we ve also been told that colonoscopies to reduce the toll of colon cancer are a life-saving intervention that many adults are missing out on.
But Dr. Welch questions the importance of colonoscopies, and downplays the role of screening for conditions such as glaucoma, diabetes, autism, and osteoporosis. Overall, Dr. Welch proposes that even if some screenings may save a few lives, this excessive screening causes people to suffer from more anxiety about their health, from drug side effects, [and] from complications of surgery.
However, ACSH s Dr. Gilbert Ross thinks that Dr. Welch may have pushed the issue too far to one side. He ignores a lot of good that screening does, notes Dr. Ross. For example, the only way to check for glaucoma is with an eye pressure test. But the early detection of glaucoma, before symptoms have begun, significantly improves outcomes. Dr. Ross additionally counters Dr. Welch s questioning of the importance of colonoscopies. The overall evidence strongly suggests that colonoscopies save lives, he says.
We certainly agree that research shows that PSA tests and mammograms are being overdone," adds ACSH s Dr. Elizabeth Whelan. But rather than insisting that almost all screening is useless or even harmful, Dr. Welch should take a more balanced stand that acknowledges the important benefits of certain screening techniques.