Dr. Prasad, what if all screening is like that? There is precious little evidence for routine colonoscopies. And mammograms may or may not be beneficial.
These and many other screenings are nothing but a way to generate more health care dollars for the industry.
Don’t get me started on prostate screening, the terrible PSA scores, the dreadful biopsies that spread infection, the unnecessary treatment. Androgen deprivation therapy has no benefit, and kills men, and radiotherapy has no benefit either. The stats are out there. The studies are there. Nobody pays atttention.
Like vaccines, routine screening seems to beneficial to the average person. Dive into the numbers, and the false positives, the unneeded treatments, the psychological toll…and ultimately no savings in lives and no extension of health span.
Shameful. But thank you for calling our attention to THIS screening which seems especially egregious in terms of lack of basis.
I'm coming to this conclusion myself. Both my parents are 70. Both have been very healthy and never really went for regular doctor visits in their adult lives. Since they both turned 70 this year (and went on Medicare) they decided to go have physicals and screenings to see how things were. My dad was diagnosed with prostate cancer. It hadn't spread, but the doc went full-bore with aggressive treatment that has left him with terrible urinary problems and ED. Horrible. My mom, they've found high cholesterol and some atherosclerosis and she's now on statin and getting a preemptive stenting (she has no symptoms, exercises, eats well, feels great.) They both have felt good and have been on no medications, and now that they're on Medicare, they're on the hamster wheel of medications and medical interventions. Are there lives better of or their overall outcomes improved by these interventions? I am doubtful.
Doubtful? Your comment says they are way worse off in terms of quality of life.There is no data to be able to say ant of these interventions will extend their lives. Your father went from healthy to an pt with incontinence
The evidence for breast, lung, and colon screening is quite a lot better than that for pancreatic cancer. There is a meta-analysis of flexible sigmoidoscopy which has a survival benefit. I'm not a huge fan of these screening programs to be clear, but I think you're making their case out to be weaker than it is.
The case really is this weak for cancers like pancreatic cancer, because it is quite a bit less common, screening tests for it have worse characteristics, and early treatment still fails most of the time.
Wow, I just yesterday had a pancreatic abdominal screening MRI with and without contrast. I have the BRCA mutation and had breast cancer 23 years ago. My doctor told me that there’s no evidence that regular MRIs make a difference but that some patients want to get them anyway. This was my first pancreas screening MRI. After reading your post, and since my doctor basically said the same thing, I’m not going to get anymore.
I so appreciate this. I am one of those "high risk" people, in otherwise good health. After watching a dear friend's last months on earth destroyed by chemo and radiation, I am sure I would choose no treatment but palliative.
(The last battery of routine tests ended with me being DISMISSED from the local gastro center because I insisted on a consultation with an actual in-person physician to please interpret their collection of results. Unbelievable.)
Out of dozens of people I have known over the last 50 years or so, some close family members, who have had cancer of some type and received radiation and chemo, only one has survived.
I have a 70 y/o patient who found out she had a pancreatic tumor as an "incidentaloma" on CT for other symptoms. It is actually not the more common "pancreatic cancer" ,but an NET with an entirely different path. But her entire life for the past 2+ years has been clouded by an overwhelming sense of doom and anxiety. I have no real idea if she will live any longer due to the treatments she's been getting (she got mixed opinions from several oncologists), but I do know that her quality of life (and that of her close loved ones) has been altered for the worse.
Still - there is a human (maybe more American) focus on "preventing bad things". There are many doctors who will hear all this and STILL feel like they want a total body MRI and should offer them to patients. At a minimum, it would be wonderful if our US insurance system did not train and badger physicians into "arm twisting" all patients into various screenings and using these as "quality measures". The European method of suggesting the options available and letting patients decide if they want to do it makes more sense.
The boondoggle of the delivery of modern medicine is overwhelming.
Sorry, what kind of Doctor are you? Neuroendocrine pancreatic tumors often have excellent prognosis. I’am 15 years up the road and have continued to work and enjoy life.
VP is referring to adeno carcinoma. There are excellent support groups to help them understand that “doom” is a bit misplaced as a full life is the goal. PNET’s often only require a monthly shot with minimal side effects.
“Modern” medicine has led to extended quality life in nearly all of us and I don’t think VP is trying to tell you otherwise.
Yes, I understand the difference between adeno carcinoma and NET. The patient cannot wrap her mind around that. Despite all of us reassuring her that she has a drastically better prognosis - she cannot wrap her mind around that and instead sits under the cloud of more typical pancreatic cancer. Her initial oncologist advised she did not even need to treat at this point, whereas a different oncologist suggested other treatment. My point is that she is likely to live quite awhile! But her daily life is definitely clouded by misery of "I have pancreatic cancer". I think she will live for some time! But her time is now much more anxious and definite lower quality of life. I find her a good example of the downside of random "screening" for very uncommon tumors/cancers. Everyone reacts differently to various diagnoses. She cannot get past the "cancer" diagnosis and feel hopeful.
No one wants the C word! But 1 in 2 of us will have some form of cancer in our lifetime. Screening in many cancers fully justifies itself. Colonoscopy routinely removes precancerous and cancerous polyps, women who are at higher risk for breast cancer by age or genetics are routinely saved from more extensive disease. Even though we may disagree on to whom screening may help I think VP would not tell you to mistrust all advice. Here he singles out a very weak and potentially harmful screening for a cancer that continues to evade us improving prognosis.
I continue to fault him for NEVER joining the conversation where I think he might modulate the extremes.
I think you misunderstood the point of my initial post. I have spent the overwhelming majority of my time and energy over the past 30 years (and still going) on following screening guidelines, counseling patients on screening options and recommendations, evaluating symptoms, diagnosing the myriad of potential "disease" states, including cancers of all types. I'm fully behind the practice of modern medicine (it's actually what I do). But periodically, I do get to see situations that highlight where more information is not an overall benefit to the person. Screening for uncommon things is not very likely to be beneficial and he points out the evidence that it really is not. My patient highlights the negative side of a random test that ends up affecting a person's ongoing quality of life in a negative way. It's been sad to see. (in her case, the test was indicated to evaluate something else - I do not regret getting the test.) But she was a much happier person in general before we ever did this test. It's a big reason we should not be doing "screening total body MRI" scans - it's an illustration of that point.
When I read the posts between you guys ,I think the difference is not theory but rather the lack of empathy with regards to knowing your patient "as a person" rather than "a symptom" . Unfortunately ,I have seen the demise of empathy , over these past few years due to hubris in allopathic medicine ( was a nurse for 20 years) and found alternative people far more relatable when it comes to having a more human conversation. Even AI has more empathy from my experience asking medical questions and a lot of other questions that are frequently dismissed .
You must mean the capitalists and their greed. This is an inherent component of “for profit” healthcare. Patient best interest is secondary to profit and responsibility to shareholders.
If modern medicine wasn't creating more disease and sickness, you guys might go out of business.
Why should we trust any studies and trials, especially after the mRNA fiasco?
I have never had a PSA or other prostate testing even in my mid 70's. So they find cancer...I would have no intention of using radiation or chemo. There are better options to try.
Can any of you doctors tell me why I am relatively healthy even with no vaccinations in over 50 years? According to you guys, I should have already died of some virus or disease.
Fear = prostate = cancer. There it is, the fear of cancer as we age. It seems to me that after engaging with the medical system (at lot less as I get older) that so much is based on fear of disease and death.
I no longer (and haven't for quite a while) trust the medical mafia. Why the heck should I? Fine, if I have a life or death emergency or come across something I can't fix, like a broken bone, I will see a doctor.
I see that we have three choices with illness: Do nothing and there is a good chance the body will repair the problem. See a doctor and get tested and drugged to death. Or, use something along the lines of herbs and natural remedies which many have been around for thousands of years. In any event, there is no (scientific) proof that doing any one of these things is better than any other. Therefore, I remain my own doctor. I am now reading Stryer's popular Biochemistry book (still used in med school, I believe) to learn more.
Until we clean house and remove these regulations we will be forever stuck with a ‘sick care’ system focused on diagnosis and treatment and not a ‘health care’ system focused on prevention through the only mechanism of merit, better diet and lifestyle. The current ‘sick care’ business model feeds like a vampire on illness, we must get sick for it to feed, and until we pay for the privilege of mistreating our bodies today, for the cost our mistreatment will incur tomorrow, we will not, we can not have a true Health Care system.
so many expensive screening diagnostics: Colonoscopies, mamograms, prostate MRIs, etc... seem of little benefit in the end... the pendulum has swung too far in terms of "early detection" it seems. I think the new found enthusiasm for blood screening will also get overused
A true free market in healthcare, without the incentive distortion of current regulations that guarantee payment to both payer and provider for unnecessary procedures, would reduce this problem to insignificance.
Once you read that 26 of 1731 patients had a screen detected cancer, it hardly seems worth finishing the paper. Over more than two decades, that is such a low hit rate. It must be very depressing to work in a clinic that only helps 1% of its patients!
Extremely disappointing that a “paper” like this made it into JAMA. Even more disappointing that the JAMA editors allowed some of the language described here.
To have 75 percent of patients with early stage disease is unheard of outside of surveillance of high risk patients. This is why the survival rate is so poor in patients who do not have surveillance (5% survival at 5 years). Early detection catches cancer at an earlier stage (usually stage I or II). In that setting survival approaches 40% at 5 years. While there may be methodological limitations to the paper, your assessment that surveillance is not warranted in high patients is flawed and misleading to those very patients. I suggest you do more reading on the topic
The tragedy is that JAMA published this crap! It used to be that the editors of journals would weed out the poorly designed studies, in order to preserve their reputation.
The other tragedy is that Johns Hopkins allowed the research to proceed and that they allowed their good name to be tarnished by the low quality publication that resulted from the “research”. Again, it used to be that such an institution would be worried about their reputation.
Dr. Prasad, what if all screening is like that? There is precious little evidence for routine colonoscopies. And mammograms may or may not be beneficial.
These and many other screenings are nothing but a way to generate more health care dollars for the industry.
Don’t get me started on prostate screening, the terrible PSA scores, the dreadful biopsies that spread infection, the unnecessary treatment. Androgen deprivation therapy has no benefit, and kills men, and radiotherapy has no benefit either. The stats are out there. The studies are there. Nobody pays atttention.
Like vaccines, routine screening seems to beneficial to the average person. Dive into the numbers, and the false positives, the unneeded treatments, the psychological toll…and ultimately no savings in lives and no extension of health span.
Shameful. But thank you for calling our attention to THIS screening which seems especially egregious in terms of lack of basis.
I'm coming to this conclusion myself. Both my parents are 70. Both have been very healthy and never really went for regular doctor visits in their adult lives. Since they both turned 70 this year (and went on Medicare) they decided to go have physicals and screenings to see how things were. My dad was diagnosed with prostate cancer. It hadn't spread, but the doc went full-bore with aggressive treatment that has left him with terrible urinary problems and ED. Horrible. My mom, they've found high cholesterol and some atherosclerosis and she's now on statin and getting a preemptive stenting (she has no symptoms, exercises, eats well, feels great.) They both have felt good and have been on no medications, and now that they're on Medicare, they're on the hamster wheel of medications and medical interventions. Are there lives better of or their overall outcomes improved by these interventions? I am doubtful.
Doubtful? Your comment says they are way worse off in terms of quality of life.There is no data to be able to say ant of these interventions will extend their lives. Your father went from healthy to an pt with incontinence
People get sucked into the medical matrix . If you keep looking you shall find ….. create fear and doubts . Fear sells .
Read the Book by Dr. Otis Brawley "How We Do Harm" SAME exact situation an
https://us.macmillan.com/books/9781250015761
The evidence for breast, lung, and colon screening is quite a lot better than that for pancreatic cancer. There is a meta-analysis of flexible sigmoidoscopy which has a survival benefit. I'm not a huge fan of these screening programs to be clear, but I think you're making their case out to be weaker than it is.
The case really is this weak for cancers like pancreatic cancer, because it is quite a bit less common, screening tests for it have worse characteristics, and early treatment still fails most of the time.
Wow, I just yesterday had a pancreatic abdominal screening MRI with and without contrast. I have the BRCA mutation and had breast cancer 23 years ago. My doctor told me that there’s no evidence that regular MRIs make a difference but that some patients want to get them anyway. This was my first pancreas screening MRI. After reading your post, and since my doctor basically said the same thing, I’m not going to get anymore.
Pls if you do, decline the gadolinium contrast. It’s heavy metal poison that deposits in your brain and cannot be chelated out.
Get some NAC to help your system after contrast IF you have to have it
I so appreciate this. I am one of those "high risk" people, in otherwise good health. After watching a dear friend's last months on earth destroyed by chemo and radiation, I am sure I would choose no treatment but palliative.
(The last battery of routine tests ended with me being DISMISSED from the local gastro center because I insisted on a consultation with an actual in-person physician to please interpret their collection of results. Unbelievable.)
Out of dozens of people I have known over the last 50 years or so, some close family members, who have had cancer of some type and received radiation and chemo, only one has survived.
I have a 70 y/o patient who found out she had a pancreatic tumor as an "incidentaloma" on CT for other symptoms. It is actually not the more common "pancreatic cancer" ,but an NET with an entirely different path. But her entire life for the past 2+ years has been clouded by an overwhelming sense of doom and anxiety. I have no real idea if she will live any longer due to the treatments she's been getting (she got mixed opinions from several oncologists), but I do know that her quality of life (and that of her close loved ones) has been altered for the worse.
Still - there is a human (maybe more American) focus on "preventing bad things". There are many doctors who will hear all this and STILL feel like they want a total body MRI and should offer them to patients. At a minimum, it would be wonderful if our US insurance system did not train and badger physicians into "arm twisting" all patients into various screenings and using these as "quality measures". The European method of suggesting the options available and letting patients decide if they want to do it makes more sense.
The boondoggle of the delivery of modern medicine is overwhelming.
Sorry, what kind of Doctor are you? Neuroendocrine pancreatic tumors often have excellent prognosis. I’am 15 years up the road and have continued to work and enjoy life.
VP is referring to adeno carcinoma. There are excellent support groups to help them understand that “doom” is a bit misplaced as a full life is the goal. PNET’s often only require a monthly shot with minimal side effects.
“Modern” medicine has led to extended quality life in nearly all of us and I don’t think VP is trying to tell you otherwise.
Yes, I understand the difference between adeno carcinoma and NET. The patient cannot wrap her mind around that. Despite all of us reassuring her that she has a drastically better prognosis - she cannot wrap her mind around that and instead sits under the cloud of more typical pancreatic cancer. Her initial oncologist advised she did not even need to treat at this point, whereas a different oncologist suggested other treatment. My point is that she is likely to live quite awhile! But her daily life is definitely clouded by misery of "I have pancreatic cancer". I think she will live for some time! But her time is now much more anxious and definite lower quality of life. I find her a good example of the downside of random "screening" for very uncommon tumors/cancers. Everyone reacts differently to various diagnoses. She cannot get past the "cancer" diagnosis and feel hopeful.
No one wants the C word! But 1 in 2 of us will have some form of cancer in our lifetime. Screening in many cancers fully justifies itself. Colonoscopy routinely removes precancerous and cancerous polyps, women who are at higher risk for breast cancer by age or genetics are routinely saved from more extensive disease. Even though we may disagree on to whom screening may help I think VP would not tell you to mistrust all advice. Here he singles out a very weak and potentially harmful screening for a cancer that continues to evade us improving prognosis.
I continue to fault him for NEVER joining the conversation where I think he might modulate the extremes.
I think you misunderstood the point of my initial post. I have spent the overwhelming majority of my time and energy over the past 30 years (and still going) on following screening guidelines, counseling patients on screening options and recommendations, evaluating symptoms, diagnosing the myriad of potential "disease" states, including cancers of all types. I'm fully behind the practice of modern medicine (it's actually what I do). But periodically, I do get to see situations that highlight where more information is not an overall benefit to the person. Screening for uncommon things is not very likely to be beneficial and he points out the evidence that it really is not. My patient highlights the negative side of a random test that ends up affecting a person's ongoing quality of life in a negative way. It's been sad to see. (in her case, the test was indicated to evaluate something else - I do not regret getting the test.) But she was a much happier person in general before we ever did this test. It's a big reason we should not be doing "screening total body MRI" scans - it's an illustration of that point.
When I read the posts between you guys ,I think the difference is not theory but rather the lack of empathy with regards to knowing your patient "as a person" rather than "a symptom" . Unfortunately ,I have seen the demise of empathy , over these past few years due to hubris in allopathic medicine ( was a nurse for 20 years) and found alternative people far more relatable when it comes to having a more human conversation. Even AI has more empathy from my experience asking medical questions and a lot of other questions that are frequently dismissed .
JAMA, as well as Johns Hopkins, have fallen to the communists and their unending personal greed.
Wonder why the name Johns Hopkins is still up on anything.. he was a slave owner ya know?
You must mean the capitalists and their greed. This is an inherent component of “for profit” healthcare. Patient best interest is secondary to profit and responsibility to shareholders.
Agreed, it worked better before the communists systematically used fear and coercion to force their ideology.
If modern medicine wasn't creating more disease and sickness, you guys might go out of business.
Why should we trust any studies and trials, especially after the mRNA fiasco?
I have never had a PSA or other prostate testing even in my mid 70's. So they find cancer...I would have no intention of using radiation or chemo. There are better options to try.
Can any of you doctors tell me why I am relatively healthy even with no vaccinations in over 50 years? According to you guys, I should have already died of some virus or disease.
Fear = prostate = cancer. There it is, the fear of cancer as we age. It seems to me that after engaging with the medical system (at lot less as I get older) that so much is based on fear of disease and death.
I no longer (and haven't for quite a while) trust the medical mafia. Why the heck should I? Fine, if I have a life or death emergency or come across something I can't fix, like a broken bone, I will see a doctor.
I see that we have three choices with illness: Do nothing and there is a good chance the body will repair the problem. See a doctor and get tested and drugged to death. Or, use something along the lines of herbs and natural remedies which many have been around for thousands of years. In any event, there is no (scientific) proof that doing any one of these things is better than any other. Therefore, I remain my own doctor. I am now reading Stryer's popular Biochemistry book (still used in med school, I believe) to learn more.
Until we clean house and remove these regulations we will be forever stuck with a ‘sick care’ system focused on diagnosis and treatment and not a ‘health care’ system focused on prevention through the only mechanism of merit, better diet and lifestyle. The current ‘sick care’ business model feeds like a vampire on illness, we must get sick for it to feed, and until we pay for the privilege of mistreating our bodies today, for the cost our mistreatment will incur tomorrow, we will not, we can not have a true Health Care system.
so many expensive screening diagnostics: Colonoscopies, mamograms, prostate MRIs, etc... seem of little benefit in the end... the pendulum has swung too far in terms of "early detection" it seems. I think the new found enthusiasm for blood screening will also get overused
Elizabeth Holmes would agree.
A true free market in healthcare, without the incentive distortion of current regulations that guarantee payment to both payer and provider for unnecessary procedures, would reduce this problem to insignificance.
Once you read that 26 of 1731 patients had a screen detected cancer, it hardly seems worth finishing the paper. Over more than two decades, that is such a low hit rate. It must be very depressing to work in a clinic that only helps 1% of its patients!
Vinay, your contribution to medicine is INCALCULABLE. Thank you!
It seems a shame that the article reviewers and/or the journal itself did not make the points you are making. The field should be better than this.
Also ... We now have visual proof that the children are leading the asylum known as the White House.
https://billricejr.substack.com/p/the-biden-cover-up-is-being-led-by
Extremely disappointing that a “paper” like this made it into JAMA. Even more disappointing that the JAMA editors allowed some of the language described here.
To have 75 percent of patients with early stage disease is unheard of outside of surveillance of high risk patients. This is why the survival rate is so poor in patients who do not have surveillance (5% survival at 5 years). Early detection catches cancer at an earlier stage (usually stage I or II). In that setting survival approaches 40% at 5 years. While there may be methodological limitations to the paper, your assessment that surveillance is not warranted in high patients is flawed and misleading to those very patients. I suggest you do more reading on the topic
The tragedy is that JAMA published this crap! It used to be that the editors of journals would weed out the poorly designed studies, in order to preserve their reputation.
The other tragedy is that Johns Hopkins allowed the research to proceed and that they allowed their good name to be tarnished by the low quality publication that resulted from the “research”. Again, it used to be that such an institution would be worried about their reputation.