Friday, January 15, 2016

2016 USPSTF breast cancer screening recommendations

The latest recommendations are finally out.

I have a beef with its recommendation for the 50-74 age group: They base their decision on the fact that reviews of studies show a decreased breast cancer mortality in those screened. However, the task force clearly knows that screening does not reduce deaths from all causes. They say so right there in their statement: "None of the trials nor the combined meta-analysis demonstrated a difference in all-cause mortality with screening mammography."

What does this mean? Well, apparently screening programs do reduce the number of breast cancer deaths (within a specified time period, eg. per year) but then increases the deaths from other causes, thus nullifying the reduction in the breast cancer mortality. So some women will not die from from breast cancer while others get the short end of the stick and die from something else instead.

So why recommend screening when it does not affect death rates from all causes? Why not underscore this vital information, make certain women know about it, and then have them decide whether they want to go through a screening regimen to reduce their risk of dying from breast cancer but then increase their risk of dying from other causes?

Tuesday, January 5, 2016

"Science has taken a turn towards darkness"

The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. 
 --Richard Horton, editor-in-chief of the Lancet 

Similar conflicts of interest and biases [as those in psychiatry] exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine. 
--Marcia Angell, former editor-in-chief of the NEJM