最近有人在 New England Journal of Medicine 上发表一篇editorial,解释不赞成每人都做 mammography 的立场。我看了觉得很有道理。这不是说谁都不该做 mammography,但是不论家庭病史和背景宣传让所有女人一过四十或五十就年年检查,我认为多半是错误的规则。
http://www.nejm.org/doi/full/10.1056/NEJMp1401875
Overdiagnosis 和 overtreatment 是一个很难解释给非医学群众的概念。有人做过抽查统计,至少一半或者更多自然死亡的老年人,在 autopsy 之中能发现生前没有发现也没有治疗过的体内癌组织。Sometimes, the cure is worse than the disease. 但是我真的不知道怎样跟人解释这件事,没有人相信。It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice.
再来一个 the cure is worse than the disease 的例子(上星期的 Fresh Air):
http://www.npr.org/2014/04/14/302899093 ... any-favors
这不是说抗生素本身不是好东西,而是说,抗生素和大多数东西一样(包括糖和剖腹产)是利弊兼备的,在尚未搞清楚长期后果的情况下,因为短期的利比较明显而滥用狂用,后患无穷。Modern Medicine May Not Be Doing Your Microbiome Any Favors
There are lots of theories about why food allergies, asthma, celiac disease and intestinal disorders like Crohn's disease have been on the rise. Dr. Martin Blaser speculates that it may be connected to the overuse of antibiotics, which has resulted in killing off strains of bacteria that typically live in the gut.
Blaser is an expert on the human microbiome, which is the collection of bacteria, viruses, fungi and other microbes that live in and on the body. In fact, up to 90 percent of all the cells in the human body aren't human at all — they're micro-organisms.
Blaser is the director of NYU's Human Microbiome Program and a former chairman of medicine there. His new book is called Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues.
He tells Fresh Air's Terry Gross that with the overuse of antibiotics, as well as some other now-common practices like cesarean sections, we've entered a danger zone — a no man's land between the world of our ancient microbiome and an uncharted modern world.