We live in an era of Fake Disease
- Thread starter Leongsam
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I learned about this when I worked with Dr James Dickinson as my preceptor at the Sheldon Chumir Centre.
He is an advocate for not doing annual physicals. No DRE no PSA without symptoms.
Dr Ted Jablonski was also my preceptor at Crowfoot Village Family Practice. He has since retired.
https://www.cbc.ca/news/canada/calgary/annual-checkups-questioned-1.4413189
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Calgary
Do no harm? Wisdom of annual checkups questioned by Calgary doctor
Overdoing a good thing can cause more harm than good, U of C prof says of fresh research
David Bell - CBC NewsPosted: November 21, 2017
For most healthy Canadians, seeing your family doctor once a year for a checkup is not only unnecessary, in some cases it could cause harm, new research suggests.
"The problem is overdoing a good thing," Dr. James A. Dickinson told Alberta@Noon on Tuesday.
"Yes, periodic health assessments, maybe every three to five years have value, there are very specific things that we can do for people that really are worthwhile. But doing them every year has dangers that we may overdo things and thereby cause harm. It's all a matter of balance."
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Dickinson is a family medicine professor at the University of Calgary and a co-author of fresh research on the value of annual medical checkups titled Periodic preventive health visits: a more appropriate approach to delivering preventive services.
'We find positives that aren't true positives'
He says the problem is doctors are hardwired to look for something and then treat it."If we do scans and other tests, very often we find positives that aren't true positives. Electrocardiograms on people who are perfectly healthy, we find minor abnormalities and then follow through," Dickinson explains.
"We can over-diagnose thyroid cancer. Three-quarters of all thyroid cancer in Canada actually isn't really a cancer that is going to kill somebody. That's a problem. We are over-treating people."
Dickinson says periodic visits for people without specific symptoms could be appropriate depending on the age of the patient.
"The annual physical is very much a North American phenomenon. Most other parts of the world don't do it. They actually do better in terms of their total health than we do in North America and it may be because when we over-treat things, we cause harm."
https://www.cbc.ca/1.6072953
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I learned about this when I worked with Dr James Dickinson as my preceptor at the Sheldon Chumir Centre.
He is an advocate for not doing annual physicals. No DRE no PSA without symptoms.
Dr Ted Jablonski was also my preceptor at Crowfoot Village Family Practice. He has since retired.
https://www.cbc.ca/news/canada/calgary/annual-checkups-questioned-1.4413189
MENU
CBC NEWS
Calgary
Do no harm? Wisdom of annual checkups questioned by Calgary doctor
Overdoing a good thing can cause more harm than good, U of C prof says of fresh research
David Bell - CBC News
Posted: November 21, 2017
Fresh research suggests annual checkups may not always be necessary, and for some people can cause more harm than good. (Matt Ryerson/The Journal-Star/The Associated Press)
For most healthy Canadians, seeing your family doctor once a year for a checkup is not only unnecessary, in some cases it could cause harm, new research suggests.
"The problem is overdoing a good thing," Dr. James A. Dickinson told Alberta@Noon on Tuesday.
"Yes, periodic health assessments, maybe every three to five years have value, there are very specific things that we can do for people that really are worthwhile. But doing them every year has dangers that we may overdo things and thereby cause harm. It's all a matter of balance."
ADVERTISEMENT
Dickinson is a family medicine professor at the University of Calgary and a co-author of fresh research on the value of annual medical checkups titled Periodic preventive health visits: a more appropriate approach to delivering preventive services.
'We find positives that aren't true positives'
He says the problem is doctors are hardwired to look for something and then treat it.
"If we do scans and other tests, very often we find positives that aren't true positives. Electrocardiograms on people who are perfectly healthy, we find minor abnormalities and then follow through," Dickinson explains.
"We can over-diagnose thyroid cancer. Three-quarters of all thyroid cancer in Canada actually isn't really a cancer that is going to kill somebody. That's a problem. We are over-treating people."
Dickinson says periodic visits for people without specific symptoms could be appropriate depending on the age of the patient.
"The annual physical is very much a North American phenomenon. Most other parts of the world don't do it. They actually do better in terms of their total health than we do in North America and it may be because when we over-treat things, we cause harm."
https://www.cbc.ca/1.6072953
Yes I asked my doc to stop doing annual PSA. All it did was stress me out. I had a reading of 1.9 to start off with. Then a couple of years later it went up to 2.5 and I started to get anxious. The next reading was 2 so I relaxed a bit. Then came a reading of 3 and I started freaking out. Turns out it was because I fucked a broad the night before which elavates the readings.
After a few years I decided that it was affecting my quality of life so I don't check anymore. What will be will be. The majority of prostate cancers are slow growing with no symptoms so what the hell. If it does kill me then so be it. After all the end of life bill has been passed in NZ so I can avoid the last few weeks of a cancer death if I so choose.
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KNN my uncle think when we do the yearlee check it is for purpose of setting our own baseline KNN psa will fluctuate throughout the day in your case it can be 1.9 to 3.0 KNN most prostrate cancer cases are pickup from a symptom + an elevated psa that could be still within the leeference range KNN
Most prostate cancers are slow growing. So most men die WITH prostate cancer not of it.
I remember that's what Dr Dickinson taught me to say to patients
Interestingly the PSA picks up these slow growing low gleason score type prostate cancers.
The fast growing ones that are more dangerous....most of the time you will have symptoms. So go by symptoms. No symptoms fuck care the PSA lah.
But you know lah the urologists still say must check and they are the specialists blah blah. And patients....asian especially they prefer to check lah "wait cancer how?"
There are many drs and patients alike who disagree with Dr Dickinson
I was thinking about what you said about masks and the data and all that while driving in my car today.
The practice of medicine is not just all science and data and numbers. It is also psychological. Meeting expectations. Trust. Reassurance. Autonomu to patients.
Thats why cannot just go by data. Just go by data is called evidence based medicine. But the urologists will draw up their data and say how many cancers they have detected and treated thus reducing morbidity and mortality.
In the end it is patient choice. And as a doctor i try to fit them with what they prefer to hear. It is an art. Easier to tell a patient what they already believe and want to hear especially when it is controversial and no right or wrong.
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How else then would you grow the fake economy and get the peasants to run continuously on the mill unless they have to do it to save their lives?
The best scam ever
The best scam ever
Your drs never tell you if PSA less than 4 usually not significant anyway? And more important is the delta. How high? 30? Yeah high man!
4.6? 5? Please lah. Maybe check in a month or two. Rising trend? Symptoms?
By then usually patient scared liao want to be referred to urologist. Your wish is my command.
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This is another doctor whose philosophy I agree with.
sebastianrushworth.com
PSA test for cancer screening: Good idea?
6-7 minutes
Should you get a PSA test to screen for prostate cancer? What are the advantages and disadvantages of screening? Do the potential benefits outweigh the potential harms? Those are the questions we will seek to answer in this article.
The problem is that prostate cancer is common, and for most people who have it, it is something that never causes any symptoms, and certainly not the thing that’s going to kill them. In medical school I was taught that the probability of having prostate cancer is about the same as the number of years you’ve lived. So, if you’re 50 years old, there’s a 50% chance that you have prostate cancer, and if you’re 80 years old, there’s an 80% chance. For most people, prostate cancer is a slow growing disease that never causes any problems. So, most people who have prostate cancer die with it, not from it.
PSA (prostate specific antigen) is an enzyme produced by the cells in the prostate. It was first discovered in the 1970’s and its biological function is to make semen more liquid after deposition in the vagina, freeing sperm to move around. It is normally present in low levels in the blood, but can increase to abnormally high levels in prostate cancer, due to the large number of cancerous prostate cells that are dividing in an uncontrolled fashion. This led to the idea that PSA could be used as a method to screen for prostate cancer, hence the PSA test.
The PSA test is simply a blood test, where you look at the level of PSA in a person’s blood. If the level is above a certain cut-off point, the value is considered “positive” (which is “positive” in pretty much the same way that being HIV-positive is “positive”), and that generally leads to a prostate biopsy being performed. And if the biopsy strongly suggests cancer, and there are no signs that the cancer has already spread throughout the body, then the prostate is usually either removed surgically, or irradiated. (If the cancer has already spread in the body, then it’s pointless to destroy the prostate – that only makes sense if there is still a chance at stopping the cancer before it spreads).
Now, for screening to make sense you need to be finding cancer in people who are going to die from it, at a point in the disease course when the cancer is still curable. The screening needs to change the course of the disease for the screened individual who has cancer, otherwise it’s meaningless.
Another aspect to screening is financial cost. From a societal point of view, the cost per case of treatable cancer discovered needs to be reasonable (at least if the tax payer is footing the bill). What a reasonable cost is, is of course something that each society needs to determine for itself.
A meta-analysis was published in the British Medical Journal in 2018 seeking to answer the question of benefits vs harms of prostate cancer screening definitively. The meta-analysis included five randomized controlled trials with a total of 721,718 men. The ages of the men enrolled ranged from 40 to 80 years old.
The screening interval varied across the studies, from a one time screening only, to once every two years, or even once a year, and the length of follow-up also varied, with the shortest follow-up period being 10 years, and the longest being 20 years.
So, what were the results? At the longest follow-up, 12,8% of men were dead in the group that received screening, and 12,9% were dead in the control group. This 0,1% difference was not statistically significant. Basically, PSA screening made no difference whatsoever to the odds of survival over the course of the follow-up period.
Now, let’s look at the negative effects of screening. As mentioned before, if the PSA test is considered positive, it gets followed up with a prostate biopsy before a decision is made whether to get rid of the prostate. One complication of this is a bacterial infection in the blood stream (sepsis). The reason you can get this complication is because the easiest way to reach the prostate with the biopsy instrument is by entering with it through the rectum, and then punching a hole through the wall of the rectum in to the prostate. When you do this, there is inevitably a risk that you will transfer bacteria that are living in the rectum in to the blood stream. Overall, 1,4% of men who were biopsied developed infections that were so severe that they had to be admitted to hospital.
If the biopsy result comes back positive for cancer, then in most cases that leads to surgery or radiation therapy, both of which pose a significant risk of impotence and urinary incontinence. The researchers calculated that, of 1,000 men screened, the screening will lead to a chain of events that will result in 25 more men becoming impotent and 3 more men developing urinary incontinence. How many of those men actually needed surgery or radiation therapy, i.e. had their lives saved by it? Probably not many, considering that the screening had zero effect on mortality.
Finally, we can look at what the review had to say about the diagnostic accuracy of the PSA test. Overall, the PSA test had a false positive rate of 67% . This means that 67% of men who have a positive PSA test don’t actually have any sign of prostate cancer when biopsied. The remaining 33% actually do have cancer, but we don’t know how many of them would ever have developed symptoms from their cancer before they died of other causes. Probably not many, or you would have expected to see an effect on mortality.
What does this all mean? Getting a PSA test for the purposes of screening is almost certainly a bad idea. The potential harms of PSA screening by far outweigh the potential benefits. While you’re considering whether to screen for prostate cancer, you might also want to consider how many blood pressure medicines you are taking, and whether statins make sense to take.
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Loctor only told my uncle high psa doesn't mean cancer low doesn't mean no cancer but they still leecommend yearly check to get a baseline reading and will only leefer to urologist if symptoms are leeported together with a elevated reading above the usual baseline KNN
It is meeting patient expectations lah.
Most asian patient go to doctor they say i want to screen for cancer. Prostate cancer also.
You expect dr to say oh donr check. Dont do PSA dont examine prostate.
The patient will say siao doctor! Waste my time. Pay him he say donr check still musr pay! Now i have to go another dr to do teat spend more money. FARK!
It is different in Canada. People have regular family drs. Screening is also free. So people go im for annual check. They talk to the dr. Dr can then have discussion.
Singapore the screening is sold as a package even. It is a business strategy also to "capture patients". They push a bunch of simplee cheaper tests all blood test.
Do they still sell things like CA125 blood test as screening for ovarian cancer in sg? Alpha fetoprotein AFP for livee cancer? CEA for colon csncer? Those are tumor markers which have no value for screening. But sold to uneducated naive sg public lah.
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KNN then just leefer lo since they are the one to pay the cost KNN if this obstruct other patient that leelee leequire the leesources then classify them as low priority if they are govt subsidised patient KNN
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KNN this is a lppl statement KNN end of the day you still need to be screened and biopsies done in order to know the patient got cancer KNN
Yes. I do refer when i was independent practice liao.
In fact is good. Cos no urologist will ever tell me why the fuck you refer PSA 4.1 to me?
Patient happy. Urologist happy. Easy for me also.
But during residency cannot lah. Working under preceptor have to guess what preceptor is like.
There were a few instances the asian patient ask me say read some article. Or want my honest opinion. Tricky. Can be trap. Some want me to say yeah dont check. Some want me to say it is bullshit how can dont check wait cancer how?
It is an art lah.
Thing is.....despite all this trickery i dont gef paid more dealing with more complicated cases or figuring out complicated minds and thinking. Not performance based. No tips allowed also. Lol!
Yeah it is very hard lah.
Wah lau musr only find cancer when it is at stage where it is curable.
Hey you think drs clairvoyant ar?
I tell you how this is done usually.
Chow kiasu dr like me. You got aome symptoms? Wah lau what if cancer? Better check lah. Even patient say canr be lah. Well most times is not lah. All happy. Patient relieved. Specialist got to do teat. I sleep well at night.
If cancer? Wah is cancer! Ok we found early! Specialist say good we found early can curable. Patirnt say thank you dr. I sleep well at night.
Meanwhile practice this evidence based medicine stuff tell patirnt dont do test dont do PSA. Then 1 year later he got some symptoms. Then we check and is cancer! Urologisr say why never do PSA last year? Is fast growing. Prognosis now not so good. Patient say fuck you lah cheebye dr tell me dont check last year what a load of shit! Only teying to save the system money save insurance company money fuck man.
Yeah trust me there will be these cases where we follow the "data" and "evidence" and then get caught pants down.
You think the patient who is told he has prostate cancer now will say yeah lah it was thd data. Dr do correct? Fat hope!
So i am more the kiasu kiasee dr for patirnt. There are no medals for me saving any system money. Or reducing use of tests that sort of thing.
If i missed a cancer and get sued i face the lawsuit alone ok!
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My uncle say KNN after 50yo life is tough la KNN so many potential diseases to fear of and still need to plan for leetirement at the same time end up also don't know got life to enjoy the fruit of labour KNN
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That’s a probability higher than lottery!
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KNN that's higher than bacarrat or same as tai sai not lottery KNN
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Thats why I am suicidal and plan to work till I die. Solve both problem
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