Results for: overtreatment
The Cancer Moonshot: Hype versus reality
The Cancer Moonshot has been promoted as a strategy to break the logjam that seems to be holding up new, much more effective treatments for cancer. The key word is "seems," because in reality the Cancer Moonshot is more hype than promise.
Whither the randomized controlled clinical trial?
With the rise of precision medicine and genomics, the conventional randomized clinical trial appears more and more outdated. Fortunately, clinical trials are evolving, but will it be enough to incorporate the numerous advances in "-omic" medicine in a rigorous scientific manner to benefit patients?
Reclassifying thyroid cancer and the willful misunderstanding of overdiagnosis
If there’s one lesson that we here at Science-Based Medicine like to emphasize, it’s that practicing medicine and surgery is complicated. Part of the reason that it’s complicated is that for many diseases our understanding is incomplete, meaning that physicians have to apply existing science to their treatment as well as they can. The biology of cancer, in particular, can be vexing....
The hijacking of evidence-based medicine
A hero of the blog, John Ioannidis, worries that evidence-based medicine has been hijacked, and when Ioannidis says something we at SBM listen. But has EBM been "hijacked"?
Confusing overdiagnosis for an “epidemic” of thyroid cancer in Japan after Fukushima
One of my favorite topics to blog about for SBM is the topic of overdiagnosis and overtreatment. These are two interrelated phenomena that most people are blissfully unaware of. Unfortunately, I’d also say that the majority of physicians are only marginally more aware than the public about these confounders of screening programs, if even that. Overdiagnosis has long been appreciated to be...
On “integrative medicine” and walking and chewing gum at the same time
Evidence matters. Science matters. However, when advocates of "integrating" quackery into medicine via the vehicle of "integrative medicine" invoke weak science and poor quality evidence in conventional medicine in response to criticism, what they are really doing is deflecting attention away from their quackery. More importantly, advocates of science-based medicine are capable of walking and chewing gum at the same time. We...
The American Cancer Society’s new mammography guidelines: Déjà vu all over again
One of the things that feels the weirdest about having done the same job, having been in the same specialty, for a longer and longer time is that you frequently feel, as the late, great Yogi Berra would have put it, déjà vu all over again. This is particularly true in science and medicine, where the same issues come up again and...
Are guidelines for calcium and vitamin D rooted in evidence, or vested interests?
Do osteoporosis guidelines overstate the benefits of calcium and vitamin D supplements? And is their continued presence due to vested interests and conflicts of interest? That’s the provocative argument made by Andrew Grey and Marc Bolland, two endocrinologists who recently detailed their analysis in The BMJ, in a paper entitled “Web of industry, advocacy, and academia in the management of osteoporosis” [PDF]....
How should we treat DCIS?
I’ve written more times than I can remember about the phenomenon of overdiagnosis and the phenomenon that is linked at the hip with it, overtreatment. Overdiagnosis is a problem that arises when large populations of asymptomatic, apparently healthy people are screened for a disease or a condition, the idea being that catching the disease at an earlier stage in its progression will...
The uncertainty surrounding mammography continues
Mammography is a topic that, as a breast surgeon, I can’t get away from. It’s a tool that those of us who treat breast cancer patients have used for over 30 years to detect breast cancer earlier in asymptomatic women and thus decrease their risk of dying of breast cancer through early intervention. We have always known, however, that mammography is an...