An Illustration of Premium Medicine
By Arnold Kling
Gina Kolata does some careful reporting in the New York Times.
Researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center report that they can save the lives of millions of people by detecting lung cancer early and treating it immediately, when it can still be cured.
…Cancer specialists have long known that all cancers – and lung cancers are no exception – include ones that stop growing and never kill or that grow so slowly that they never cause problems if they are simply left alone. So, some of them ask, how many of the people said to be cured were never in danger? And how often will people have operations that can involve removing part of a lung, and that can themselves kill a patient, when their cancer was not lethal? The problem, as with other cancer scans, is that science today cannot always tell the difference between cancers that will stop and those that will go on to kill.
The other question that researchers ask is slightly different: How often did the scans find cancers early but without affecting the person’s life expectancy?
“Everyone knows we can pick up things better with screening,” said Dr. Elliott Fishman, a professor of radiology and oncology at Johns Hopkins Hospital in Baltimore. “But is picking up the same thing as curing? If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing.”
It turns out that the study was so poorly designed that it fails to answer these sorts of objections. The article ends on a note suggesting that consumers themselves need to assess the implications.
[Dr. Smith] said, “it is not at all unreasonable for individuals at high risk of lung cancer to seek testing on their own.”
Others, like Dr. Ned Patz, a professor of radiology, pharmacology, and cancer biology at Duke University Medical Center, say that they suspect patients’ ardor for the testing might cool if they hear the full story about the uncertainties and risks.
Thanks to reader Trent McBride for pointing me to the story, and for relating it to the themes in Crisis of Abundance.
“A lot of patients ask about it,” he said. “We counsel them and tell them what the data are. Then they are not interested.”