Good Medicine: Do As Much Nothing As Possible

Good Medicine: Do As Much Nothing As Possible

''The delivery of good medical care is to do as much nothing as possible''

~ Samuel Shem, The House of God

Medicine is undergoing an existential crisis today. Its core value proposition – to help and not hurt -- is failing to manifest. Patients are suffering. Doctors are suffering. The only exuberant party on the battlefield against disease is the pharmaceutical industry. An industry whose annual causalities far exceed the death total from our two decade long involvement in the Vietnam war. 

The entire system is on the precipice of a collapse, if not for economic reasons alone, then certainly for ethical and intellectual ones. The irony is that the system has become so ineffective and dangerous that avoiding medical treatment (excluding perhaps emergency care) has become one of if not the best healthcare strategy you can implement to protect your health and well-being.

Nowhere is this clearer than in the realm of cancer. Over the past few decades, billions have been spent on screening asymptomatic populations to "prevent cancer," with the result that millions have been assigned with questionable diagnoses (e.g.,"early stage-" or "stage zero-cancers") and then shepherded into chemo, radiation and surgery treatments as if watchful waiting, or better yet, making significant nutritional and lifestyle modifications, would be a suicidal approach vis-à-vis the inexorability and presumed lethality of genetically-determined cancer.

We needn't detail the misery this approach has produced, but suffice it to say that despite the industry's claims of thousands of "lives saved" from the detection of "early cancers," breast and prostate cancer specific mortality has at best stayed the same, and may have actually increased in some cases. In light of the fact that the financial costs of misapplied treatment in some cases is so high that the uninsured, their families, and society as a whole, face bankruptcy, the situation is dire indeed.

Even after the cat was let out of the bag in 2013, and a National Cancer Institute commissioned expert panel concluded that labeling screening detected lesions known as ductal carcinoma in situ (DCIS) and high-grade intraepithelial neoplastic hyperplasia (HG-PIN) (colloquially labeled as "breast cancer" and "prostate cancer," respectively) as carcinomas ("cancer") is no longer justified. Instead they opted for redefining what were previously considered potentially lethal cancers as "benign or indolent lesions of epithelial origin." Yet, you hear virtually no mention of this change anywhere. Tens of thousands are still being diagnosed with the same "cancers" and being cut, poisoned and burned, without informed consent.

The lack of acknowledgment and discussion about these tremendous diagnostic "errors" is less surprising when you consider that about 1.3 million U.S. women were wrongly treated for breast cancer in the past 30 years, with prostate and lung cancer representing two additional icebergs upon which the Titanic cancer industry is presently running itself aground upon, regardless of whether the medical establishment will accept responsibility. Ignoring the truth that millions suffered needlessly, it would seem, is less painful than admitting wrong, and dealing with the psychological and financial fallout that inevitably follows. But is it possible to stem the tide much longer against the inevitable transformations brewing?

If you check the pubmed.gov statistics, interest in "overtreatment" and "overdiagnosis" has grown exponentially from only a few decades ago, when the terms were rarely mentioned. A new editorial, titled,  "It Is Overtreatment, Not Overdiagnosis," points out the real issue behind the epidemic of cancer overdiagnoses:

The most widely accepted definition of ''overdiagnosis'' is ''diagnosing a person without symptoms with a disease that will (ultimately) never cause symptoms or death during the person's lifetime'' (2). It should not be confused with misdiagnosis or false-positive findings, which are completely different entities and outside the scope of this commentary. As the generally accepted definition encapsulates downstream effects (ie, ''would otherwise not go on to cause symptoms or death'', the real issue lies with ''overtreatment'' of these accurate diagnoses rather than overdiagnosis itself.

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Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.

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