Abstract
Remarkable advances have been made in medicine over the past century, with much of acute disease having succumbed to successful therapies in the Western world to be replaced by many chronic illnesses. 1 –4 Meanwhile, extraordinary technological advances during the past 50 years have permitted more accurate diagnoses for a wide variety of disorders. However, one of the unfortunate consequences has been the overuse of technology in the drive for earlier and earlier detection of diseases. In a carefully researched book, Alan Cassels, a drug policy researcher affiliated with the University of Victoria (in the capital of the Canadian province of British Columbia on Vancouver Island), has described the problem in his latest book Seeking Sickness. The text consists of 11 chapters plus a prologue and an epilogue, a foreword by H. Gilbert Welch, MD, MPH, from the Dartmouth Institute for Health Policy & Clinical Practice, and an extensive bibliography and endnotes. The topics covered in the text include whole body scanning, screening for glaucoma, cholesterol screening, prostate-specific antigen testing, mammography screening, colonoscopy, Pap smears, mental health screening, lung cancer screening, osteoporosis screening, and gene screening, as well as self-screening for diseases. Chapter 1 begins with a debunking of the whole body scanning hype that “a full body scan can save your life” (p. 1). Chapter 4 clearly elucidates the problems with the screening for prostate cancer using the prostate-specific antigen test, which identifies as positive too many individuals with either no cancer or a low-grade cancer that will not significantly progress before the man dies of other disease. Even the clearly successful Pap screening comes in for comment by Cassels, when he highlights the overzealous use of this test, as, for example, in the annual screening of a woman who at that time was 82 years old and had never previously had any abnormalities detected. Chapter 8 on self-screening discusses the pharmaceutical company manufactured “low-T” disease and its associated advertising campaign to alert men to a Web-based questionnaire that could indicate their need for testosterone supplementation (to be then followed by the pharmaceutical company hoped for pressure by these men on their primary care physicians to prescribe testosterone).
Overall, this is a relatively short and very readable book that should raise the awareness of health care practitioners and patients alike to the dangers of excessive screening for medical conditions.