Category: Diagnostic tests & procedures
Certainty versus knowledge in medicine
I don’t want knowledge. I want certainty! — David Bowie, from Law (Earthlings on Fire) If there’s a trait among humans that seems universal, it appears to be an unquenchable thirst for certainty. It is likely to be a major force that drives people into the arms of religion, even radical religions that have clearly irrational views, such as the idea that...
Bogus Diagnostic Tests
A few years ago a friend asked me to comment on advice given to her adult daughter by a psychiatrist whom she’d consulted for depression. The psychiatrist had recommended testing samples of saliva and urine for hormone and neurotransmitter levels, the results of which would likely indicate a need for supplements to correct deficiencies or imbalances. According to the psychiatrist, who had...
Time to Care: Personal Medicine in the Age of Technology
In 1925, Francis Peabody famously said “The secret of the care of the patient is in caring for the patient.” A new book by Norman Makous, MD, a cardiologist who has practiced for 60 years, is a cogent reminder of that principle. In Time to Care: Personal Medicine in the Age of Technology, Dr. Makous tackles a big subject. He attempts to...
James Ray and testosterone replacement therapy (TRT)
For the last four years I have served in a volunteer capacity among a panel of pharmacotherapy experts queried regularly by the ABC News Medical Unit about breaking or upcoming news involving the efficacy and safety of drugs and supplements. Where appropriate, I provide background information that informs the story. My incentive is largely to put my time where my mouth is...
Another wrinkle to the USPSTF mammogram guidelines kerfuffle: What about African-American women?
A while back I wrote about rethinking how we screen for breast cancer using mammography. Basically, the USPSTF, an independent panel of physicians and health experts that makes nonbinding recommendations for the government on various health issues, reevaluated the evidence for routine screening mammography and concluded that for women at normal risk for breast cancer, mammography before age 50 should not be...
The USPSTF recommendations for breast cancer screening: Not the final word
Preface: On issues such as this, I think it’s always good for me to emphasize my disclaimer, in particular: Dr. Gorski must emphasize that the opinions expressed in his posts on Science-Based Medicine are his and his alone and that all writing for this blog is done on his own time and not in any capacity representing his place of employment. His...
The cancer screening kerfuffle erupts again: “Rethinking” screening for breast and prostate cancer
I see that the kerfuffle over screening for cancer has erupted again to the point where it’s found its way out of the rarified air of specialty journals to general medical journals and hence into the mainstream press. Over the last couple of weeks, articles have appeared in newspapers such as the New York Times and Chicago Tribune, radio networks like NPR,...
Are one in three breast cancers really overdiagnosed and overtreated?
Screening for disease is a real pain. I was reminded of this by the publication of a study in BMJ the very day of the Science-Based Medicine Conference a week and a half ago. Unfortunately, between The Amaz!ng Meeting and other activities, I was too busy to give this study the attention it deserved last Monday. Given the media coverage of the...
Screening Tests – Cumulative Incidence of False Positives
It’s easy to think of medical tests as black and white. If the test is positive, you have the disease; if it’s negative, you don’t. Even good clinicians sometimes fall into that trap. Based on the pre-test probability of the disease, a positive test result only increases the probability by a variable amount. An example: if the probability that a patient has...
PSA – To Screen or Not to Screen
Is the prostate specific antigen (PSA) test worth taking? It's, like, really complicated.