In the future, you’ll be able to monitor your health in real time with an electronic tattoo; your diet will be tracked by a device stuck to your tooth; and you’ll have a lab-on-a-chip wearables to detect early signs of disease. With such fine-grained details available, people should be healthier than ever, right?
Perhaps not. Some doctors think the opposite may be true — that in many cases, health technology has led us to over-diagnose problems that wouldn’t ever be harmful, causing patients unnecessary anxiety and leading to unneeded interventions.
Physician H. Gilbert Welch, who has dedicated much of his career to combating over-diagnosis, summed up the problem to New Scientist as such: “Do people want medical care as a way to deal with acute problems; things that are bothering them? Or do they want to take the power of medicine to look hard to try to find things wrong with them?”
As health technology grows more sophisticated and more personal, this problem promises to grow. Already, we can see this happening with a particularly tricky disease: cancer, which thanks to liquid biopsies, breath scanners, blood tests, and AI systems, doctors are becoming good at catching early on.
It’s hard for doctors and patients alike to hear the word “cancer” and decide to just wait and see. However, some cancers are actually very low-risk to patients, as they grow slowly or not at all. Some even disappear for no apparent reason.
Yet Welch’s most recent research found U.S. hospitals that order more CT scans also had higher rates of kidney removals, as these scans tended to find small kidney cancers. Patients and doctors then treated these small cancers aggressively, even though a large portion of these masses are usually harmless. That means many patients potentially underwent the trauma of surgery for no reason.
Similarly, research into polycystic ovary syndrome (PCOS) found that diagnosing women with the condition (which can cause infertility and risks of diabetes and cardiovascular disease) caused significant emotional and physical issues even when they had no symptoms. And in breast, thyroid, and prostate cancers, more screening and more diagnoses have not led to a significant reduction in the number of patients who develop advanced stages of these cancers.
Ultimately, it seems the issue of over-diagnosis is one of balance. As a blog post from Cancer Research UK puts it, the benefits of screening for early-stage diseases outweigh the harms for whole populations; yet for an individual person, the decision whether to act on what they find — or whether to be screened at all — should be a choice informed by the actual risks. The same will be true of technology that gives us an ever-finer focus on any change in our bodies.
Information is power, but it has to be used such that people don’t make themselves sick in pursuit of health.
