ABC Radio National Health Report, March 6, 2006, was the last of a
3-part series on, "Cancer Screening, Benefits and Harms", see:
http://www.abc.net.au/rn/healthreport/stories/2006/1582008.htm#
The following transcript extract adds an additional reason why pathology
tests are increasing.....
Alex Barratt: Dr Gil Welch, a physician with the US Department of
Veterans Affairs.
Today we're going to look at how you might make your own decision about
which cancers, if any, you want to be screened for. Before that though
let's take a look at the forces that drive cancer screening. As we've
seen over the last two weeks, cancer screening has some pretty big
downsides. Yet almost everyone's strongly in favour of it. So the
question is why there's so much public and professional enthusiasm for it.
Gilbert Welch: There's no single answer to that question. I think there
are a number of explanations. Just the idea of early cancer detection is
just so appealing. People are very genuinely scared by cancer and
there's a widespread belief that gee there's no reason not to look for
cancer early, and there's every reason to look for it early.
And this is part of a broader culture that uncritically accepts medical
testing is a good thing, without recognising that testing does have
downsides, that it does find things that otherwise wouldn't bother you,
and that it can start a chain of events that's very difficult to stop.
Now I'd like to add a couple of other drivers, and it would not be
correct not to bring up the topic of money. There are strong incentives.
One of them is obviously for the test manufacturer or for the physicians
that interpret them, whether they're mammographers or radiologists,
they're good business right. Because they involve a lot of people, so
they're big markets.
It's also become in the interests of medical centres to find cancer
early. I'd like to read a quote by Otis Brawley, a urologist who went on
to be a director of the Georgia Cancer Centre and worked at Emory
University. He wrote that 'We at Emory had figured out that if we screen
a thousand men at the North Lake Mall this coming Saturday we could bill
Medicare and insurance companies for about 4.9 million dollars in health
care costs'.
But he goes on to write that the real money comes later from the medical
care that the wife will get in the next three years because Emory cares
about her man, and from the money we'll get when he comes to Emory's
emergency room when he gets chest pain. I think there's a lot of
interest in garnishing patients, and one way to get patients is to offer
free screenings.
Alex Barratt: Dr Gil Welch. One current example of a significant
commercial opportunity is the test for human papilloma virus, the virus
that causes cervical cancer. Not surprisingly the test is being strongly
promoted by its makers, Digene who think it should be incorporated into
cervical cancer screening because they argue it's good for women. But
there's a lot of dispute about whether it would actually add anything to
screening other than a lot of anxiety and cost.
Dr Angela Raffle is a world leader in research on cervical cancer
screening, and she's had a close look at what Digene's been up to in
promoting the HPV test.
Angela Raffle: The British medical Journal carried an article saying
that perhaps we should solve all the problems in cervical screening by
using HPV testing. And our newspapers are full of photographs of very
well known celebrity women who apparently were campaigning for all 15
European nation states to introduce HPV testing into the cervical
screening program right away, Carol Smiley, Honour Blackman, Jilly
Cooper. I think they would be the most prominent.
Well fortunately a very astute investigation of a journalist spotted
that something strange seemed to be happening. And he contacted all the
celebrities who were named on the website for the group. None of them
knew that they had anything to do with the campaign. He managed to track
down who'd set up the campaign which wasn't easy because it all traced
back to a PO Box in Brussels. Nobody was allowed to divulge who'd set it
up. But it turned out to be Burson-Marsteller which is a big PR company
who were working on behalf of Digene, and they'd completely manufactured
the whole celebrity group.
Alex Barratt: And they had done it to put pressure on governments in
Europe and the UK, to include HPV testing as part of the screening program?
Angela Raffle: They'd done it precisely for that. And it creates the
impression that oh well HPV testing must be a good thing because all
these very high profile women must have independently looked at the
evidence and made their minds up.
Alex Barratt: Dr Angela Raffle runs the NHS Breast and Cervical Cancer
Screening Programs in Bristol, England.
Research in the prestigious journal of the National Cancer Institute
found that 70% of US women and 60% of men had seen celebrity
endorsements in the past year. About a quarter said the endorsements
made them more likely to be screened.
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
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