Korea's Thyroid-Cancer "Epidemic" - Screening and Overdiagnosis . The short version is as follows: the ability to screen for thyroid cancer led to an explosion (an almost unbelievable 15 fold increase) in its diagnosis. In fact, it's now the most common cancer in South Korea. Nevertheless, the mortality rate hasn't budged. That means the only thing screening managed to accomplish was thousands of needless biopsies and surgeries and their occasional complications, including death.

There's an excellent Op-Ed piece by one of the paper's authors in The New York Times that lays it all out but this line really caught my attention:

Too many epidemiologists concern themselves not with controlling infectious disease, but with hoping to find small health effects of environmental exposures - or worse, uncertain effects of minor genetic alterations. Perhaps they should instead monitor the more important risk to human health: epidemics of medical care.

Will this finding which clearly echoes the results of similar studies on the impact of mass screenings for prostate cancer and breast cancer and their respective diagnosis and mortality rates finally dampen the enthusiasm for screening? Not if the new screening recommendation for type 2 diabetes, and the public's response to prior news about the impact of mass screenings, is any indication.

The U.S. Preventive Services Task Force (USPSTF) now recommends blood glucose screening for adults at increased risk of type 2 diabetes. Among those many risk factors are being aged 45 or older, BMI > 25 and having a close relative with type 2 diabetes. That's not exactly everybody but it's certainly a lot of bodies. So how many lives will be saved? Given that this is a Grade B recommendation and that the USPSTF's review of the evidence led it to conclude that first-line therapy for diabetes prevention (aggressive lifestyle modifications) currently results in a lower incidence of diabetes, cardiovascular mortality and overall mortality you'd assume the answer would be "many". However, "the task force found inadequate direct evidence that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity."

That doesn't sound very promising. So why make such a recommendation? Who knows? Given the enormous political pressure recently brought to bear on the USPSTF (especially after its recommendation against screening mammography in women under 50) it would be easy to slide into cynicism and speculate about the potential motives of those (other than the undiscovered incipient diabetics) who stand to benefit from this new recommendation (remember: under ACA if the USPSTF recommends it, it gets paid for). Instead, since this is a mass torts blog, I'll speculate about why the new thyroid-screening study notwithstanding, most folks will enthusiastically line up for another screening opportunity.

Despite widespread coverage and laudatory editorials in leading newspapers both left-leaning and right the evidence that mammography screening in those at negligible risk did more harm than good apparently had little effect. No Fall In Mammogram Rates After USPSTF Recommendations was the conclusion drawn from surveys of the attitudes of almost 28,000 women about screening. The same was true for elderly men and prostate cancer screening (though it must be noted that urologists and middle aged men have demonstrated significant reductions in rates of screening / being screened). So why do so many people go to the bother of having a diagnostic test that is sure to be an annoyance and almost just as sure to do no good? I propose it's because of one of the greatest decision drivers of all and one effective plaintiff lawyers use to devastating effect. It's fear of regret.

Think about the power of fear of regret in the context of the reluctance of parents exposed to stories about autism and vaccines to vaccinate their children. They're weighing the chance of autism times its cost against the chance of irreversible brain damage from measles times its cost. Should they decide that the value of the former outweighs the value of the latter it can only be that, given the grossly unequal risks, they've added something quite heavy to that scale holding the price of their children not developing autism in order to bring it even with the costs their children not be brain damaged by measles. What could it be? I suspect that it's fear of regret / fear of becoming blameworthy.

In looking back across some of the most effective jury arguments I've seen (as determined by damages subsequently awarded) it's those taking the form of "If you don't stop this company, one day you'll learn of another death and that victim's blood will be on your hands" that work best. It's the argument that appeals not to sympathy but that rather instills the social fear of shame that does the most work. Be en garde.