| Someone else linked to https://thennt.com/nnt/screening-mammography-for-reducing-de... Quote: > "Two recent data reviews deserve further mention. The United Kingdom commissioned an independent review after dissenting voices swelled, for the purpose of better informing shared decision making and educational materials about the harms and benefits of screening.6 Unfortunately the review concluded that screening mammography trials were inadequately powered to detect an impact on all-cause mortality, and therefore used breast cancer mortality as a primary outcome. They concluded a 20% reduction and used this in their discussion of harms and benefits. As noted above, cause-specific mortality is both scientifically unstable (conclusion reversal is common when all-cause mortality is considered)7 and disease-centered rather than patient centered (patients would prefer to avoid death altogether). Thus, either screening mammography does not save lives or else we have inadequate data to say whether it does or does not. In neither case can a benefit be scientifically claimed." > "They concluded a 20% reduction and used this in their discussion of harms and benefits." We want to do things that will help people. On an individual level, people have the right to make decisions for themselves. At the population level, we should do things that can be proven to be helpful. This leads to decisions that feel heartless - denying people a vaccine during a deadly pandemic while it is being tested; delaying or denying introduction of a new medicine that shows only marginal improvements over an old one. So their independent review showed benefit by changing the criteria for comparison. We want to help people, and medical interventions feel like helping. Unfortunately, sometimes they can be the equivalent of The Politician's Fallacy: "There was a problem. I did something about the problem. Therefore the problem is fixed" > "As noted above, cause-specific mortality is both scientifically unstable (conclusion reversal is common when all-cause mortality is considered)7 and disease-centered rather than patient centered (patients would prefer to avoid death altogether)." People die of /something/. That thing becomes a target to fix; and we deploy resources to fix it. We become emotionally connected to some interventions. (Speaking personally, I'm participating in a bike ride in a few weeks to raise money for breast cancer screenings.) Some of those resources are beneficial, some are not, some may be harmful. > "Thus, either screening mammography does not save lives or else we have inadequate data to say whether it does or does not. In neither case can a benefit be scientifically claimed." |