Saturday, April 30, 2011

Gary Schwitzer on MPR

Gary SchwitzerGary Schwitzer, creator of the great site, was on MPR's Midday program yesterday. I missed the middle of the show, but came back in time to get the idea he had criticized Katie Couric for her first-person colonoscopy report a few years ago.

Not because she did a bad job of representing the process -- he acknowledged it had a value in that sense -- but because she had no reason to get a colonoscopy at the age she was then, and thus misinformed the public about the need for the test. We already have people getting MRIs and CTs they don't need; no need to have legions of younger boomers and Gen Xers demanding colonoscopies early. Even though her husband had died of colon cancer at age 42, that had no bearing on her own health, or the recommendations on when people in general should be screened.

Schwitzer's critique of Couric ties into our tendency to think all screening is good, when actually that's not supported by the evidence. As with the brouhaha about mammogram recommendations, it's important to balance the number of people "saved" by screening against the number harmed by unnecessary, invasive procedures that result from false positives. That's what the age-50 recommendation for colonoscopies (and mammograms) is meant to accomplish.

Schwitzer spent more of his time on the show explaining the criteria his site uses to evaluate medical reporting, and noting that 70 percent of the coverage fails to meet even the first three:

  • What's the total cost?
  • How often do benefits occur?
  • How often do harms occur?
  • How strong is the evidence?
  • Is this condition exaggerated?
  • Are there alternative options?
  • Is this really a new approach?
  • Is it available to me?
  • Who's promoting this?
  • Do they have a conflict of interest?
Schwitzer said: "When you take those three things, if you're failing seven times out of 10 on costs, harms and benefits, you're giving the American public a kid in a candy store view of U.S. health care, where you make everything look terrific, risk-free, and without a price tag. Nothing could be further from the truth."

Well worth a listen, and his site is one to check frequently.

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