Flip side of screening

[TheChamp-Sharing count="1"]

The paramount catch-phrase, ‘prevention is better than cure’ needs some second thought overhauling, especially with respect to screening tests done to detect possibility and presence of disease in its earliest stages.

The mainstay of prevention against diseases is to identify the risk factors associated with them and their early termination.  

One of chief purposes of screening tests is to identify risk factors for certain diseases.However it has been observed on a regular basis that when screening of a large population is done with an aim of identifying  related risk factors with a particular disease, the results lack  some clarity and are largely inconclusive.

A screening test is done on a person who is not ill but is at a risk of catching a certain disease. So, on detecting the presence of an early disease,there is an advantage of treating it early.This sounds full of logic and reason and it is true to some extent, but not in an absolute sense.Treating a disease in its earliest stages does make sense only if it leads to a better outcome than treating it late.

Many diseases show good results of screening and their early treatment, but not all.Diabetes,hypertension,anemia and hypothyroidism etc. can be combated in early stages by virtue of intelligent and timely screening tests whereas many types of cancer even detected early on screening couldn’t help in enhancing human longevity.

Many times, a preventive treatment started after detection of a significant risk factor (like detection of a cervical polyp developing into cervical cancer) was not really needed as the person involved might have not developed the grave outcome as expected.Such an approach in turn, overburdens the person with over-treatment  besides labeling him with a disease which he may never suffer from.

Moreover, the procedures of some screening tests are harmful to certain extent. X-ray scans expose the body to radiation and endoscopy can cause unwelcome bleeding.Even their specificity and sensitivity are questioned besides the prevailing dilemma over their false positive and false negative results.

 So, there is definitely a flip side of screening tests,but there is a way out of this mess.

The WHO has defined the criteria for evaluating screening tests.It says that screening should be done for diseases with serious consequences only .The screening tests should be reliable.There should be an effective treatment available for the diseases screened.And above all, neutral information should always be available to people, to enable them decide for themselves if they are willing to undergo a test or not.

Tracemydoctor practices high standards in screening its cherished clients by following strictly the WHO guidelines.Its prime aim is to educate people regarding duality of screening. The benefits and disadvantages are explained to them in detail which helps them  in final decision making regarding the choice of a screening test.

 by Blue Lotus ,  at Tracemydoctor

Lack of holism & over-treatment

[TheChamp-Sharing count = "1"]

Are the doctors over-treating their patients? Are the consultants and super specialists increasingly  behaving like mountebanks in the era of failing healing wisdom and  therefore propagating over-treatment in the process? I hope they are not doing this act of negligence on their part.

Well, looking into the deeper picture, one can clearly see a fabricated prosthesis limping across the corridors of medical fraternity.There is an identity crisis all over. A rat race is on, with a hurried ambitious lust of becoming a big shot in the arena of medical premises,making them lose their reason and judgement in the process.

The Gatekeepers are no more  able to keep the doors safe and healthy as the everchanging and surmounting R&D overwhelms the consultants at the tertiary level,leave aside the poor primary care personnel. The connection between primary and tertiary systems of healing are fast disintegrating as the cost of treatment soars up the sky because of poor planning and vested interests.And the adventures of pharmacy adds to this chaos and pity.

In this atmosphere of discomposure, the demon called ‘over-treatment’ rises out  of arrogance and helplessness on the part of our medical professionals. Arrogance, because they overlook the basic principles of our masters, deluded by the false pride of scanning vast medical literature  and helplessness, coming out of ever continuous generation, elimination/refutation and regeneration of new hypotheses  in medical R&D overburdening even the most hardworking and sincere practitioner.

The demon knows that the healing infrastructure is discriminated and compartmentalized in addition to lacking holism , the binding principle. In spite of lead-time check-ups, screening intelligence and subclinical acumen, a conditioned ignorance hinders right clinical judgement in the very earliest stages of discomfort reported by the patients.

On looking closer, this poorly conditioned medical expertise ranges from Popper’s refutationism, which  undermines clinical decision- making by limiting it only to best available empirical evidence without any reasoning to self-contained deductive logic with poor premise and no extrapolating abilities. Even the Bayesian induction is helpless to some extent unless an intense individualization is practiced in each case.

An absolute lack of aptitude for reasoning and inferring from extrapolation of the earliest narration of discomforts by the patients in his own words, make them lose the first true opportunity of medical intervention.This inaptitude on the part of certain therapeutic methods where they are unable to relate these very early peculiar and individualistic verbal-symptoms of discomfort to any evidences around make them helpless in preponing the lead-time period to the left on its timeline.Thus the detection of discomfort/disease is delayed.

Moreover, an all prevailing  ego forbids a referral around to other complementary treatment methods where the first reaction coming from patient’s mind and his narrative could easily detect the discomfort even before the conventional lead -time for the patients at risk.A single peculiar statement from horse’s mouth could start the journey to ideal cure.The physicians should develop this aptitude of extrapolating and reasoning out the very first information report coming out of patient’s mind.But a laggard attitude on the part of physician forces the poor patient to wait helplessly for the development of evident clinical picture and start of treatment after the clinical diagnosis,where the probability of overtreating him with drugs increases manifold because of late intervention.

Now as higher up the poor patient moves in the system,more the demon drains him ultimately giving him iatrogenic organ failures in the name of most advanced treatments making him wonder where on the way he lacked sincerity in fighting against his disease. He did report to the primary care on  first appearance of his discomfort with all verbal acuity possible. And as the sick is confused and the healing is in disarray, overtreatment is poisoning him to such a deceptive state where it is impossible to judge the true killer, if it is the disease or the drugs?

All that aforesaid view may sound very paradoxical and bombastic but it is crystal clear when  one analyzes the data of hospital visits ,in any particular disease, where most of the cases show up for a medical advice during the earliest stages only as that is the time when the first deviations from the comfort zone of his mind and body  puts him on highest alert. But the physician mishears him as the narration of his discomfort is non-specific and not physically/clinically oriented so that he just can’t relate his narration to any of the available medical evidences around, because of its subtlety.

The big question is that who is responsible for it? In my opinion the dominant school of main-stream conventional medicine, the big brother, should take this responsibility as it gets the most patient-exposure and forward least early referrals to other methods of treatment.Therefore propagating the most of untoward effects of medication in the process.Iatrogenic catastrophe abounding in their medical records confirms to this humble affirmation.

The emphasis to cure is poorly placed and mistimed in relation to various methods of treatment and their acuity of intervention. All the methods are here to treat the sick within their scope and limits.We just need to explore the right time of intervention for them to take action.It is not only the physicians’ responsibility to catch the discomfort the earliest but an extraordinary state of awareness on the part of patient is equally needed to perceive the preliminary signals of discomfort.

 A holistic cooperation is badly needed among various schools of therapeutic methods in order to overcome  the limitations of a particular method and to give the best of our services to the suffering humanity.If we do this, we will surely avoid the burden of overtreatment and keep a check on this demon.

Tracemydoctor is judiciously open to all established schools of therapeutics to execute its plans of action thus minimizing over-treatment.


by BLUE LOTUS, at Tracemydoctor