However, what happened now is that we have a massive increase in autism, and it does not have the downstream effect of improving children. We should see a slightly happier population, but everything we see is good mental health. We have done something well -intentioned, but there is no evidence that it works.
The reason why this does not work is that when you get to the very soft end of a range of behavioral or learning problems, you have a balance between the advantage of being diagnosed with the help you can get, and the disadvantages of being diagnosed, which indicates to a child that he has an abnormal brain. What does that do to the belief of a child in themselves? How will it stigmatize them? How does that affect their identity training? We thought it would be useful to tell the children, but the statistics and the result suggest that it is not useful.
You also worry about another aspect of the diagnosis, which is overhaul. An example you give in the book concerns modern cancer screening programs that detect disease at stages earlier and softer. But so far, there is little evidence that these are really beneficial for patients.
Each cancer screening program will lead some people to obtain treatment when they did not need to be treated. This will always be the case. What we are desperately disputing is that we want to make sure that we keep the number of overdowed people and the number of people who need treatment. However, the more you do these tests, the more overdowed you will have. I read in a Cochrane review that if you detect 2,000 women, you save a life and you treat in a place between 10 or 20 women. You always surprise many more people than lives you really save. So the suggestion that we should do even more of these tests before perfecting those that we have no meaning for me.
I do several brain scans per week and many of them show accessory results. Even if I am a neurologist and I see brain scanners all the time, I don’t know what to do with half of them. We just don’t know how to correctly interpret these scans. We have to pay more attention to the detection of symptomatic diseases early, rather than trying to detect asymptomatic diseases that may never progress.
In some cancers – property cancer, for example – patients can opt vigilant wait Rather than treatment. Should this be the standard for early detection?
If you are going to go for screening – and I don’t want people not to operate for suggested projections – you need to understand the uncertainties and realize that you don’t have to panic. Of course, at the minute you hear, there are cancer cells, panic comes into play, and you want it and you want the maximum treatment. But in fact, in medicine, many decisions can be made slowly. There are vigilant waiting programs.
I want to suggest to people that, before leaving for screening, know that these uncertainties exist, so that you can decide before the test comes back positive what you think you would like to do, then you can take the time to think about it after, and you can ask for a vigilant waiting program.
I think that one of the solutions would be to call these abnormal cells that we find on screening something other than “cancer”. As you hear this word, the immediate reaction of people is to get it out, because otherwise they think they will die. The vigilant wait is just something that people have trouble doing.
Hear Suzanne O’Sullivan talk to Cable health March 18 in Kings Place, London. Get tickets Health.wired.com.