Minor Thoughts from me to you

Richard Posner on the problems that come with increased tests for preventative medicine. Are we going too far?

The tendency has been to move the goalposts: to screen for lesser and lesser abnormalities, even though the lesser the abnormality the lesser the expected disease cost to the patient and so the less likely the screening and follow-up treatment are to provide net benefits. Moreover, mild abnormalities are far more common than severe ones, so that moving the goalposts greatly increases the number of persons who have to be screened. When the threshold for excessive cholesterol was lowered from 240 to 200, the number of Americans with excessive cholesterol increased by almost 43 million and all of them are recommended to take drugs to reduce their cholesterol, even though the benefits for persons who are not at high risk of heart disease for other reasons are highly uncertain—yet many of these persons are taking the drugs along with persons who can anticipate a significant benefit. The increased prevalence of screening and preventive treatment has increased the health awareness of Americans and by doing so has increased the innate anxiety that people feel about sickness and mortality.

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