Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about:

Screening healthy people for possible disease is often seen as a way of preventing serious health problems. But how much do you know about the benefits–and the risks–of screening? Whether it is regular mammography for healthy women or PSA tests in men with no symptoms of prostate trouble, screening can detect abnormalities that would never cause harm. Investigating them further, however, does have a potential for harm.

This issue can be emotionally charged, as the response to the recent article on mammography in the BMJ demonstrated. Although the scientists found no survival benefit from screening mammography after a follow-up of 25 years, many women insisted that a screening mammogram had saved their lives.

For a better understanding of the potential for overdiagnosis and how it could lead to overtreatment, we explore the concept of the number needed to treat: the NNT. How many people need to take a cholesterol-lowering drug for one life to be saved?

Guests: Alan Cassels is co-author, with Ray Moynihan, of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients and co-author, with Gil Welch, of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. The photo is of Mr. Cassels.

David Newman, MD, is director of clinical research and professor of Emergency Medicine at the Icahn School of Medicine at Mt. Sinai Hospital in New York City. His website is thennt.com

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.



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  1. CMc

    Any suggestions on how to find a good doctor who practices holistic medicine and limits procedures and drugs? I am very interested in that approach but don’t know where and how to find such doctors.

  2. Ed

    Regarding full body CT scans, they will benefit one group. That group is cancer doctors and the entire medical oncology industry. One CT scan of the chest is the equivalent of about 270 chest x-rays. That’s many lifetime’s worth of x-rays in a single scan. Now multiply that over the entire body and the amount of radiation received is staggering. My advice is avoid CT scans unless there is no other viable alternative.

  3. Loriann Ells

    Thank you for this eye opening show. Sadly, most patients think the medical system has their best interest at heart. I recently dodged knee surgery thanks to an orthopedic doctor on YouTube. I had a torn meniscus and the knee surgeon I was sent to said knee surgery was a must.
    I fled his office as fast as my painful knee would take me… with he and his staff having a good laugh. That was 4 years ago. Did not have surgery and my knee is just fine thank you. Loriann

  4. J David Auner

    Screening tests and criticisms of screening tests are touchy subjects. Kudos for taking on this subject which will be hard for some entrenched power structures (moneyed folks) to accept or for the patients to accept who think their lives will be improved by the tests.
    Vaccines vary widely in importance and effectiveness against terrible disease and death. Given the availability of effective medications which, given early, prevent most cases of chronic pain from herpes zoster (shingles) I agree this vaccine should have a limited use. DPT and the American polio vaccine along with MMR save lives, brain damage, deafness and other neurologic damage and I would not like to see the patients again with lock jaw, congenital deafness or measles encephalopathy.
    Perhaps a vaccine update would interest listeners. This might take several shows to cover the various available therapies in depth.

  5. Alan Cassels

    I apologize to AC who felt I was a bit too flippant in discounting the discomfort or invasiveness of the Pap test. It is very true that these tests can be extremely unpleasant for women, and you are absolutely right that, like any screening test, there is a risk of overdiagnosis including the risk of unnecessary hysterectomies. Like any test, it’s always best to go in with your “eyes wide open”, and only agree to it after you’ve satisfied yourself that you’ve had a very close look at the potential harms and potential benefits of the test. Screening is not an emergency procedure so you do have time to do your homework before you go ahead with the test. As well, recommendations on who should be tested and when are always changing so it’s worth looking at the most up-to-date screening recommendations from reputable (and non-conflicted) sources. I wrote an article about that subject a while ago:

  6. A.C.

    I always love the show, and what an excellent guest! Thank you. Buy one thing that perplexes and disappoints me is how he glazed over the pros and cons of pap tests. I recognize that he has the disadvantage of never haven gotten a pap test, but I would not call it a relatively non-invasive procedure. It’s extremely invasive, unpleasant, and even painful for some women! However, I’m far more concerned with the over-treatment it causes. According to Dr. Angela Raffle, we need to treat 1000 women for 35 years to prevent one death. Meanwhile 150 would receive abnormal results, 80 would need further investigation, and 50 would get unnecessary procedures.
    I have many, many, many friends who’ve undergone painful, invasive cervical procedures for supposedly “pre-cancerous” conditions. Many of them have gone on to have fertility issues, prolonged labor, and difficult births. Pap tests may also lead to unnecessary hysterectomies. (An estimated one third of women get one before age 60!) I would love to hear an expert on your show focusing on the harms and benefits of pap testing and applying the same sort of “healthy skepticism” your guests have to mammograms, PSA, and cholesterol screening. In addition to actual physical harm, the large number of false positive pap tests reap huge psychological distress for women.
    You can see Raffle’s study here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153831/

  7. James Everett, RN

    I have been listening to your program for a few years now. I find that your guests are very informative.
    Having been a registered nurse for more than 20 years now, I have come to believe that the system is broken, to say the least. I agree with Alan Cassels position that the industry is seeking and selling sickness. I am assisting my mother with her healthcare, doctors appointments, etc. I am the filter between my mom and the doctors who want to order different tests, prescribe certain medications,etc.
    I wish that everyone had a healthcare advocate, to help make informed decisions about the best care plan, for their condition. If we do not speak up, big pharma will speak for us!

  8. Judy

    It is not surprising that the previous comment was written by a doctor. I used to have an MD neighbor who unwisely shared with me jokes that doctors tell among themselves… It only confirmed to me what I already knew.. By the way, my neighbor died young of an entirely preventable condition! Allen Cassels, and those sharing his concerns and work are heroes!
    I also know doctors who, very successfully, practice holistic medicine, and use MOSTLY natural healing methods and remedies with tremendous results. They resort to “conventional medicine” only when all else fails. (Have you ever heard of a Zoloft or Cumadin deficiency???)
    Ultimately, everyone of us is responsible for our own health. No doctor can control what, or how much we put into our mouths, whether we exercise, get enough rest, or sleep, etc. Taking control over our health also requires continually educating ourselves, listening to excellent programs such as People’s Pharmacy, reading books and articles presenting information about healthy eating habits, and a healthy lifestyle in general – the best preventive care of all.

  9. EHD

    I worry that this anti-diagnostic mindset will cost lives. At age 50, annual physicals were not recommended for people of my age group. I went to the doctor for another problem and he discovered nodules on my thyroid with led to the diagnosis and removal of papillary thyroid cancer. It was sheer luck that I received diagnosis, which would have been picked up with an annual physical.
    Does Cassels feel the same way about colonoscopy? Again, a precancerous “troublesome” polyp was discovered in my ascending colon, which would not have been caught by the cheaper, less invasive sigmoidoscopy.

  10. Charles Beauchamp MD, PhD

    It was very interesting to hear this gentleman’s comments about what can be constructive in a dialog about clinical prevention between a patient and physician. His comments reflect a lack of understanding of what can occur in clinical prevention if both the patient and physician take a biopsychosocialcognitive approach to the issue where there is an integrated look at how the mind (cognition), mood (emotions), membership (community or population), matter (physical body) inter-relate and allow the patient and physician to come together regarding clinical prevention of onset, progression, recovery antagonism, complication and palliation blockage.
    I believe this gentleman’s nihilism re clinical prevention could be replaced by progressive optimism and even clinical outcome facilitation if only we apply ourselves more to that end.

  11. Marie

    Thanks to Alan Cassels and Peoples Pharmacy.
    I have been enjoying your articles/books for quite some years now.
    I live in Sweden and “discovered” you on the Internet.
    I would also like to recommend Alan Cassels monthly column on http://www.commonground.ca.

  12. MOB

    I am a healthy 73 year old. The best medicine is a good diet of lots of fresh vegetables and fruit from our own garden, good conversation at meals and a glass of wine, hard exercise, always cook everything from scratch. Don’t opt into any X-rays or tests you can’t understand. Keep your body parts because they were included for a reason.
    Don’t take antibiotics unless you have a red stripe going up your limb or you are facing death by pneumonia. Never go to a hospital if you can avoid it. Enjoy life!

  13. CMC

    I listen to the program most Saturdays on KERA. Why is so much common since lacking?

  14. w r b

    great program have him on again and again Thank You.

  15. Arlean L.

    I listen every Sat. morning to your show and always find it interesting and informative. This morning’s show (Feb. 22) resonated with me when your guest talked about the DCIS diagnosis.
    I got my annual mammogram in 1998 and was informed that I should return for an biopsy. After the biopsy, my doctor strongly recommended that I must be sure to return for my mammogram the following year to keep a close watch. In 1999, I dutifully returned and once again a biopsy was ordered. This time I was informed that I had DCIS and that I should begin taking Tamoxifen.
    By this point, I was tired of playing the breast flattening and biopsy game, and so I decided that I would not get anymore mammograms, or biopsies, nor would I take any recommended drugs.
    That was almost 15 years ago. I am now 74 years old. I take no drugs, nor do I go in for any tests to see if I am mortal. I am a flexitarian and try to eat lots of fruits and green veggies. I exercise at least 30 minutes each day. My weight has balanced between 110-115 (5’2″) all my adult life except for my two pregnancies.
    It might be interesting to note that my sister who is 2 years older than I am (and has always believed that my life style was ludicrous) just went through her second mastectomy and this week finished her chemo therapy sessions where she is in total misery minus her hair. We are not twins, but it might be interesting to study siblings who have a similar genetic heritage but extreme differences in life style.

  16. jbr

    There is something wrong with the radio station’s equipment. Terry and Joe are clear and understandable but your guests that are on the telephone are garbled to the extent that we often turn them off because we cannot understand a word they are saying.
    Can you remedy this problem????

  17. Judy E. Buss

    BRAVO, BRAVO, BRAVO!!! Thank you for introducing us to Alan Cassels’ important and yes, lifesaving work! THANK you Alan Cassels!!! This all goes back to taking control of our health, and not acting like sheep, and being victims of industries bent on making a killing (pun intended) on non-existing illnesses!
    I am 70 years old, and not on ANY medication, and neither is my husband. We eat super healthy, and exercise daily, and do our best to stay away from doctors like from the plague.
    One of the worst “seeking illness” industries, is the dental profession, performing X-Ray tests almost every time one goes in, even for a small cavity, or a”check up”. (They don’t do this to me – because I refuse!) This is done to kids too, on a regular basis – God help us!!!!

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