An unmeasured harm of screening: a physician’s perspective

Posted By



A perspective piece in the Archives of Internal Medicine by Dr. Vinay Prasad of the Medical Oncology Branch of the National Cancer Institute tells a sad tale of what is headlined, “An Unmeasured Harm of Screening.”

It’s a story of a 65-year old man who was screened for abdominal aortic aneurysm with ultrasound followed by CT scan.

The overly-condensed story is this:

  • Aneurysm found.
  • Detailed informed consent leading to endovascular repair (stent graft).
  • 6 months post-procedure, the graft had totally occluded.
  • Emergency surgery, then 3 more operations over 2 months.
  • The man was still left with “foot drop” necessitating use of a walker.
  • A month of rehab that he called “the low point of my life.”
  • “Today, Mr. R, by his own account, is a shell of his former self,” acccording to the article.

The author concludes:

“This study highlights a number of complicated issues in health care. First, Mr R was appropriately consented for surgery; however, in hindsight he wishes different information were presented to him. The informed consent process is often long and complicated, but it remains unclear if it best communicates what some patients want to know. Second, translating data from randomized clinical trials (RCTs) to individual patients, who often differ from those participants in the RCTs, remains an uncertain affair. Third, data are often extrapolated from older studies. The data from the cited screening example were collected between 1997 and 1999, prior to the development of endovascular repair. Finally, how quickly should physicians respond to new data, and are data from only 1 or 2 studies sufficient to change practice?”

Such examples should not be confined to the pages of medical journals.  Consumers need to read about these as well.

Our 6.5 year experience in reviewing health care news stories on shows a clear and overwhelming pattern of messages that emphasize/exaggerate the potential benefits of medical interventions and minimize or totally ignore potential harms.

You might also like

Comments (2)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Leslie Nolen | The Radial Group

November 5, 2012 at 10:02 am

Totally agree – screening and preventive care in general have a “minimax” problem – minimize potential harms, maximize potential benefits. And usually what’s missing is context – putting the potential harms/benefits in terms of NNN and similar frames of reference.