It pains me to watch patients throw all their “health chips” into dangerous tests and treatments.
“I don’t want to take any risk.”
A natural reaction. We all crave certainty about our health. We feel that if we do something – endure some test or medicine – then we will have done all that we can to escape disease. Unfortunately, most of those tests and medicines do a lot LESS to cut risk than we have been led to believe. The disease may come anyway. And if the treatment itself has added more risk, then what kind of game are we playing? The pursuit of health becomes a high-stakes poker game.
How much are you willing to gamble? How much do you really understand about the risks to your health?
Research shows that most people – including doctors – have a highly distorted sense of medical statistics. It is very easy to succumb to the scary one-line statistical sound bytes that abound in the health industry.
Risky Odds of Mammograms
Screening mammograms are a good example. We are told that mammograms “reduce breast cancer deaths by 30%”. 30%- wow! But what does that mean?
Many of my patients have a vague understanding that this means that if they don’t have a mammogram, they will have a 30% chance of dying. That is far, far from reality. The chance of dying from breast cancer is relatively rare to begin with – nowhere near 30%. And mammograms cut that risk by only the slightest amount. The same studies that generate the 30% statistic can also be interpreted to say that screening mammograms cut the absolute risk of dying over 10 years by a miniscule 0.1%. Less impressive.
“Mammography could save your life, but it’s a long shot” – Dr Gilbert Welch, Dartmouth Institute for Health.
There are real risks with mammograms. There is significant radiation exposure. And then there are the false negatives and the false positives. Not concerned about false positives? You should be. It could mean that you are unnecessarily subjected to risky biopsies, surgery, radiation and chemotherapy. Many women are.
The 2009 Cochrane analysis says that for every 2000 women undergoing 10 years of annual mammogram screening:
- 1 women will have her life prolonged
- 10 healthy women will undergo unnecessary treatment (including mastectomy, chemo and radiation)
- 200 healthy women will suffer significant psychological stress and invasive testing due to false positive results.
Public health experts are concerned. They say that current written materials about mammography “overestimate benefits and neglect harms” . They warn doctors that they have an ethical obligation to inform women about the possible harms of mammogram screening.
Humans make decisions based on emotion. Cancer is scary, so if the word cancer and a number like 30% are floated about, then most women and doctors will be scared into gambling with screening mammograms.
If the facts about false positives and over-treatment were made clear, then some women would decide to reject mammograms. And that would be a perfectly reasonable choice!
“A decision not to get screened can be as sensible and responsible as the decision to get screened.” – Dr. Jorgensen from Nordic Cochrane Center.
Get ALL the Information Before You Make a Medical Decision
Unfortunately, life is full of risk. You may ward off imaginary breast cancer just to suffer health damage from unnecessary treatment. Try to see the big picture and attempt to minimize risk from all angles. Sometimes the best way to minimize risk is to NOT have the medical procedure.
Some medical procedures are a good gamble. Some not so good. As individuals, we must try to find the right health gamble. We must make an attempt to understand medical statistics, because our doctors won’t do it for us.
Don’t let fear and snapshot statistics drive you. It is understandable that when you are sick and scared, you just want to do “whatever it takes” to make this one particular condition go away. But consider: What will you gain? Does the procedure really offer a health guarantee – or is that just wishful thinking? And by over-treating this one condition, are you putting yourself at significant risk for something else?
It’s about information.
1) Thyroid radiation treatment.
Some cases of over-active thyroid are severe, and require radiation treatment. However, my clinical experience is that thyroid radiation treatment is over-prescribed. Doctors are trigger happy with this one, for some reason. Maybe because it’s a seemingly tidy solution, but they seem to lose sight of the fact that over-active thyroid is very often a temporary condition.
I have spoken to many patients who refused radiation, only to have their mild thyroid condition resolve on its own. Less happy patients are those who accepted the radiation therapy for what appears now to have been Hashimoto’s thyroid disease. I saw this many times in my Sydney clinic. Hashimoto’s is a slow-progressing thyroid condition that over time can develop into under-active thyroid. Unfortunately, Hashimoto’s can also have an initial brief phase of thyroid over-activity. Some unlucky patients are given radiation treatment during this interval, so instead of having a relatively mild condition that may lead to under-active thyroid, these women find themselves with a permanently inactivated thyroid. They are bound to thyroid replacement for the rest of their lives, and although doctors might say that lifelong thyroid medication is “as good” as a functioning thyroid, that is just not true.
2) Chemotherapy for early-stage breast and prostate.
Research shows the chemotherapy given for the early stages of these cancers is most often unnecessary and does more harm than good. And harm from chemotherapy can be very serious harm indeed. Most medical experts are concerned about this issue. We are desperately in need of new, more accurate diagnostic techniques to decide who really needs chemo.
Women take this drug because they’re told that it will cut their risk of breast cancer recurrence by 50%. Many women think: if I don’t take it, I might have a 50% chance of dying. Wrong. The 50% means that the chances of recurrence over 10 years drop from 6/1000 to 3/1000. 3 out of every 1000 women that take Tamoxifen will have recurrence anyway. 3 will be helped. All 1000 women will be subjected to a new and significant risk for uterine cancer caused by the drug.
4) Androgen ablation for prostate cancer.
In 2008, a study in the Journal of the American Medical Association (JAMA) assessed the treatment outcome for 19,271 men with prostate cancer. They determined that the commonly prescribed testosterone-lowering treatment (chemical castration) benefited only a minority of patients. Those with advanced prostate cancer (22% of cases) did slightly improve their survival rate, but those with localized cancer (78% of cases) were more likely to die of the cancer if they received treatment than if they received NO treatment.
Chemical castration is awful. It causes impotence, fatigue, bone fractures, diabetes, and heart disease. All to negligibly reduce the risk for cancer. Any poker players out there? How do you want to play your hand?
5) Cholesterol medication.
Many patients believe that to stop cholesterol medication even temporarily – risks imminent heart attack or stroke. In reality, the evidence is that the medication does very little to prevent heart attack, even after years of use. Large, convincing studies show that most people get no discernible risk-reduction from cholesterol-lowering medication. The medication does offer a mild protective effect for those patients with a history of heart attack, and that is the evidence that is held up to the rest of us. That is the evidence that fuels the fear for the millions of people who religiously take this drug. Even if the medication were significantly protective (which it is not), it is still possible to have a heart attack while on the medication. It is not a magic talisman pill. Definitely not a guarantee. Heart attack risk is closely linked with other blood test markers such as homocysteine, C-RP and cortisol. (Topics for a future post.)
For those patients who suffer cholesterol medication side effects such as brain fog, memory loss and muscle pain, it is perfectly reasonable to try some months off the drug. I assure you that you’re not risking death any more than the rest of us do on any given day.
Antibiotics do not work for the common cold. Period. The cold is a caused by a virus, not a bacteria. Many patients – and doctors – do not seem to realize this. They feel that antibiotics are something to take just in case the infection is bacterial or becomes bacterial. 60% of common cold patients leave their doctor’s office with a prescription for antibiotics.
The Center for Disease Control is very concerned. They have declared November 14 the week to “Get Smart about Antibiotics”. They hope to get the message out that antibiotics should NOT be taken for every sniffle and cough. That to take them contributes to the growing and very serious problem of antibiotic-resistance.
In terms of personal risk, antibiotics cause other problems. They disrupt good intestinal bacteria, and this can lead to diabetes, arthritis, thyroid disease, allergies, cardiovascular disease, breast cancer, obesity, Parkinson’s disease, depression and many other conditions. Serious conditions. Are they worth risking “just in case” your sniffle might be bacterial?
A patient may decide that it is worth suffering the side effects and cancer risk of tamoxifen to avoid a 3 in 1000 chance of breast cancer recurrence. If she makes her decision based on those numbers, and not on doctor-bullying or fear, then she is giving informed consent.
Ask your doctor for the fine print. Look beyond the glossy sound-byte statistic that is thrown at you and attempt to examine the real information about the medical procedure that you are being offered.
Yours in Health,