A retrospective cohort study in the bmj to determine the availability of data on overall survival and quality of life benefits of cancer drugs approved in Europe concluded that
‘…most drugs entered the market without evidence of benefit on survival or quality of life…’ and ‘when there were survival gains over existing treatment options or placebo, they were often marginal’
“Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13”. Courtney Davis et al.
How many patients (and doctors) are unaware of the range of variability in diagnoses that can derive from the same pathology sample? How much accepted ‘certainty’ is, in fact, ‘uncertain’? Read on, and you may never want to accept a diagnosis without getting a second opinion – or a third.
When Diagnostic Uncertainty Hits Home. Joann Elmore. BMJ Opinion, 28 June 2017.
The article includes some useful links eg http://www.nejm.org/doi/full/10.1056/NEJM199412013312206
‘Variability in Radiologists’ Interpretations of Mammograms. Joann G. Elmore, Carolyn K. Wells, Carol H. Lee, Debra H. Howard, and Alvan R. Feinstein
N Engl J Med 1994; 331:1493-1499 December 1, 1994 – which calls for efforts to improve accuracy and reduce variability in interpretations of mammography.
Posted in biopsies, Breast Cancer, breast screening, Campaigns, cancer, citizen safety, diagnoses, harms, healthcare modernisation, information, medicine's flaws, Over-medicalisation, overdiagnosis, patient safety, patient/doctor communication, Public safety, Screening, Screening Mammography
Tagged health, medical, science, testing
In my rapid response to this BMJ article I should have mentioned GP payments that were given for not referring patients. Does anyone else have the sense that there are also cut-off points for referral, diagnostic investigations or treatments at say age 75? Or above? That’s certainly the impression I’m getting from friends and colleagues.
Prescribing incentives feel grubby because they are. Margaret McCartney. BMJ 2017;357:j2695
In this New England Journal of Medicine paper, Welch and colleagues discuss whether wealthier people receive too much care – ie more than is good for them. “Excessive testing of low-risk people produces real harm, leading to treatments that have no benefit (because there is nothing to fix) but can nonetheless result in medication side effects, surgical complications, and occasionally even death.’
Income and Cancer Overdiagnosis – When Too Much Care is Harmful. H Gilbert Welch, Elliott S Fisher. N Engl J Med 376;23, 2208-2209. June 8 2017. http://www.nejm.org/doi/pdf/10.1056/NEJMp1615069