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A few words on #prevention.
When I rail against prevention, some assume I am not interested in preventing disease.
This is not true. I am.
I found this paper from @JuanGrvas et al that helps explain my tension about prevention.
cadernos.ensp.fiocruz.br/csp/public_sit…
When I rail against prevention, some assume I am not interested in preventing disease.
This is not true. I am.
I found this paper from @JuanGrvas et al that helps explain my tension about prevention.
cadernos.ensp.fiocruz.br/csp/public_sit…
This article discusses the precautionary principle as it relates to screening and prevention of disease. Here you have 2 concepts--additive preventive measures and reductive preventive measures--taken from G Rose.
I love reductive measures. Avoidance of bad stuff--smoking, donuts, French fries, driving a car too much etc. @nntaleb calls this via negativa artofmanliness.com/articles/via-n…
The problem comes when we embrace additive preventive measures. These are generally "professional-led interventions that are alien to human ecology, economy, and physiology." Eg...mammography, colonoscopies, PSA, Vascular screening drives and of course AF screening.
Whereas reductive prevention confers no risk, ... "The safety, technical, and bioethical requirements to approve an additive preventive measure are greater due to their embedded potential harms."
So when we consider additive prevention and its layers of uncertainty, we must apply the precautionary principle -- first, do no harm.
When we do stuff to people... The #medicalconservative feels strongly that the onus of proof of benefit and lack of significant harms lies on those who promote additive prevention.
Take DOACS for stroke prevention-- here the evidence for benefit is clear.
Take DOACS for stroke prevention-- here the evidence for benefit is clear.
But screening programs that lead to small reductions in death from one (of gazillions) disease does not count. If you want to expose people to medicalization, show me that doing so reduces all-cause death.
Despite the enthusiasm for screening, the actual evidence for screening is very weak. ncbi.nlm.nih.gov/pubmed/25596211
And the harms are real nejm.org/doi/full/10.10…
And the harms are real nejm.org/doi/full/10.10…
So I love prevention, but you have to show me it works without harming people. A basic question should be: does prevention help the testers or the tested?
