However, now it has happened that we have a huge escalate in autism and this has no lower effect of improving children. We should see a slightly happier population, but everything we see is worse mental health. We did something well, but there is no evidence that it works.
The reason why it does not work is that when you get to a very gentle end of the spectrum of behavioral problems or learning, you have balance between the benefit of diagnosis with the support you can get, and the disadvantage of diagnosing what he tells the child that he has an abnormal brain. What does this do with the child’s faith in himself? How does it stigmatize them? How does this affect their identity? We thought that this would be helpful to say to children, but statistics and the result suggest that this is not helpful.
You are also worried about another aspect of diagnostics, which is an exaggeration. One example that you give in the book concerns newfangled cancer screening programs that detect the disease at an earlier and milder stage. But so far there is little evidence that they are beneficial to patients.
Each cancer screening program will lead to the treatment of some people when they did not have to be treated. It will always be like that. We are desperately spinning, it is that we want to make sure that we maintain the number of people from excessively diagnosed and the number of people who need treatment. However, the more sensitive you perform these tests, the more excessively diagnosed people you will have. I read in the Cochrane review that if you check 2,000 women, you save one life and treat somewhere between 10 or 20 women. You always give much more people than life that you really save. So the suggestion that we should do even more of these tests before we improve the ones we have, there is no point for me.
I do many brain scans a week and so many of them show random arrangements. Although I am a neurologist and I see a brain scanning all the time, I don’t know what to do with them. We just don’t know how to interpret these scans correctly. We need to pay more attention to the early detection of symptomatic diseases, instead of trying to detect asymptomatic diseases that may never act.
For example, in some cancer – cut cancer – patients can choose vigilant waiting instead of treatment. Should this be the early detection standard?
If you are going to go for screening – and I don’t want people not to go for suggested shows – you must understand uncertainty and realize that you don’t have to panic. Of course, when you hear that there are some cancer cells, panic collapses, and you want and want maximum treatment. But in fact, many decisions can be made slowly in medicine. There are vigilant waiting programs.
I want to suggest to people that before you go to the examination, know that these uncertainties exist so that you can decide before the test returned, which you think you want to do, and then you can spend some time to think about it later, and you can ask for a vigilant waiting program.
I think that one of the solutions would be to call those abnormal cells that we find after sifting something other than “cancer”. When you hear this word, the immediate reaction of people is to get it out, otherwise they think they will die. General expectation is simply something that people are tough to do.
Listen to Suzanne O’Sullivan speak Wired health March 18 at Kings Place, London. Get tickets on Health.wired.com.