Table Of ContentA
L
“Smartly written and very readable.”
A
BRIAN GOLDMAN, MD, N
author of The Night Shift
C
A
“Alan Cassels strips layers of expectation, hype, S
FOREWORD BY DR. H. GILBERT WELCH
S
jargon, false-starts, and conflicts of interest
E author of Overdiagnosed: Making People Sick in the Pursuit of Health
off the medical screening mantra.” L
NORtIN M. HADLER, MD, S
author of The Last Well Person
S e e k i n g
Seeking Sickness takes us inside the world of medical S
screening, where well-meaning practitioners and a E
S i c k n e S S
profit-motivated industry offer to save our lives by exploit- E
ing our fears. Author Alan Cassels writes that promoters k
of screening overpromise on its benefits and downplay its
i
harms. If you’re facing screening for breast or prostate can-
N
cer, high cholesterol, or low testosterone, someone is about Medical Screening
g
to turn you into a patient. You need to ask yourself one
question: Am I ready for all the things that could go wrong? and the Misguided Hunt
S
ALAN CASSELS is a drug policy researcher at the University i
of Victoria, in British Columbia, and is the co-author (with C for Disease
Ray Moynihan) of the international bestseller Selling Sick- k
ness: How the World’s Biggest Pharmaceutical Companies Are
N
Turning Us All into Patients.
E A L A N C A S S E L S
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$18.95
www.greystonebooks.com
Cover design by Setareh Ashrafologhalai
Cover photograph © Chris Whitehead/Getty Images
Printed in Canada on ancient-forest-friendly paper
Distributed in the U.S. by Publishers Group West
Ebook also available.
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seeking sickness
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A L A N C A S S E L S
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FOREWORD BY DR. H. GILBERT WELCH
S e e k i n g
S i c k n e S S
Medical Screening
and the Misguided Hunt
for Disease
A L A N C A S S E L S
d&m publishers inc.
Vancouver/Toronto/Berkeley
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Copyright © 2012 by Alan Cassels
Foreward copyright © 2012 H. Gilbert Welch
12 13 14 15 16 5 4 3 2 1
All rights reserved. No part of this book may be reproduced, stored in a
retrieval system or transmitted, in any form or by any means, without
the prior written consent of the publisher or a license from The Canadian
Copyright Licensing Agency (Access Copyright). For a copyright license,
visit www.accesscopyright.ca or call toll free to 1-800-893-5777.
Greystone Books
An imprint of D&M Publishers Inc.
2323 Quebec Street, Suite 201
Vancouver bc Canada v5t 4s7
www.greystonebooks.com
Cataloguing data available from Library and Archives Canada
isbn 978-1-77100-032-1 (pbk.)
isbn 978-1-77100-033-8 (ebook)
Editing by Catherine Plear
Cover design by Setareh Ashrafologhalai
Text design by Naomi MacDougall
Cover photograph © Chris Whitehead/Getty Images
Printed and bound in Canada by Friesens
Distributed in the U.S. by Publishers Group West
Some of this material was previously published
in a different form in Common Ground, The Tyee, and
the Canadian Medical Association Journal.
We gratefully acknowledge the financial support of the Canada
Council for the Arts, the British Columbia Arts Council, the Province
of British Columbia through the Book Publishing Tax Credit,
and the Government of Canada through the Canada
Book Fund for our publishing activities.
Greystone Books is committed to reducing the
consumption of old-growth forests in the books it publishes.
This book is one step towards that goal.
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For Earle Cassels
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contents
ix foreword by Dr. H. Gilbert Welch
xi prologue: Seek and ye shall find
1 chapter 1: The whole body scan
Who’s really reaping the benefits,
and why you don’t need one
16 chapter 2: Screening for eyeball pressure
Know the right questions to ask (for any
screening test) and when to ask them
27 chapter 3: Cholesterol screening,
syndrome X, and heart scanning
The risky business of screening for risk
41 chapter 4: psa testing
What are the odds?
55 chapter 5: Mammography screening
The politics, the promises, and the numbers
66 chapter 6: Colon and cervix screening
Too much of a good thing?
81 chapter 7: Mental health screening
We’re crazy, just not that crazy
95 chapter 8: Self-screening for disease
Planting the seeds of self-doubt
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106 chapter 9: Lung screening for cancer and copd
Finding disease in every breath you take
117 chapter 10: Bone screening
Selling screening
128 chapter 11: Gene screening
When marketing precedes science
143 epilogue: A conversation starter
when facing screening
What happens if I do nothing?
147 bibliography
149 endnotes
167 acknowledgments
169 index
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foreword
H. Gilbert Welch, md, mph
the last fifty years have seen dramatic changes in medical care.
Many have translated into real improvements for patients—most
notably for those are who genuinely sick, for whom diagnoses are
now both more prompt and more accurate and for whom treat-
ments are now both more effective and less morbid.
But not all of the changes in medical care represent real
improvement. Many have produced much more mixed effects:
perhaps helping some, but also hurting others.
Case in point: Fifty years ago, doctors made diagnoses and ini-
tiated therapy only in patients who were experiencing problems.
Of course, we doctors still do that today. But increasingly we also
operate under a new paradigm: seeking diagnosis and initiating
therapy in people who are not experiencing problems. That’s a
huge change in paradigms, from one that focused on the sick to
one that focuses on the well.
Think about it this way: In the past, you went to the doctor
because you had a problem and you wanted to learn what to do
about it. Now you go to the doctor because you want to stay well
and you learn instead that you have a problem.
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