http://www.thisamericanlife.org/radio-archives/episode/391/m...
It is not the actual screenings that I particularly care about -- that is just data. The elephant in the room is the implied massive amount of overtreatment that are justified on the basis of the screenings -- overtreatment that inflicts a tremendous physical, emotional, financial, and health toll on the patient.
What are the long term health costs of unnecessary chemotherapy? Is it ethically okay for a doctor to inflict torturous poisoning (chemotherapy) on a patient for fear of potential lawsuits, when it could easily be true that 75% of those patients gain zero medical benefit?
How could you possibly know it whether or not it's necessary?
That is extremely strong evidence that American doctors are applying a painful & damaging treatment far more often than can be rationally justified.
And how are you measuring mortality?
By the number of women who actually die of breast cancer.
Suppose, normalized for population size, 1000 women of a certain age die of breast cancer in both country A and country B. In country A, 5000 women are treated with chemo. In country B, 20000 women are treated with chemo.
Which country has the more competent doctors? I think the answer is obvious.
Hint: The USA is not country A.
You're trying to oversimplify something that isn't simple.
By the way, exactly what country are you talking about here?
I'd think in the general case, yes. The patient is going to want it, even if it is only 25% effective. I'm not an expert on medical ethics, but in my mind if the patient has complete information and still wants the treatment, the doctor is not morally bankrupt in providing it. The doctor can certainly advise otherwise if they choose, of course.
The patients are scared. Doctors are playing on those fears, acting on the assumption that fast and aggressive treatment is the wisest course all the time. The patients are reacting out of fear, not getting second opinions, and are hurried into the operating table to be cut open.
That is the norm. I have seen it happen.
It is my personal opinion that, no, most doctors are not offering complete information. So your argument, while reasonable, simply does not apply.
In such a case it is very easy to see how it would be possible for the patient to choose treatment which is in fact against their best interest.
Also, as mentioned elsewhere in the thread the current regulatory/legal climate leaves a vanishingly small upside and massive downside to the doctor who would advise against treatment.
However, having served on a hospital credentials committee, and bearing witness to what type of lawsuits medical providers have been subject to, I can assure you that if a physician advises against a screening mammogram to a woman in her early 40's despite the fact that there are "organizations" that encourage it, and she ends up with breast cancer and possibly dies, that physician will get sued and will in all likelihood lose, or have to settle. Task forces can make all kinds of recommendations, but unless there are changes to the legal system to back them up , don't expect major changes. Somewhere in this discussion it was suggested that doctors are ignorant. It is, in fact, the exact opposite.