Epidemics Avoidable and Unavoidable

Excerpt

Some epidemics are unavoidable—the Black Plague, the Spanish Flu, polio before Salk and Sabin. Others are avoidable. Within this category of avoidable epidemics are those caused by doctors themselves, as they over-test, over-diagnose, and over-treat. These iatrogenic epidemics are not rare; they include the spate of prostate cancer diagnoses resulting from PSA testing, the rash of breast cancer treatments administered to the estimated one-third of mammographically diagnosed breast cancers with limited biological potential to cause harm,1 and the recent deluge of patients treated with fibrates for “hypertriglyceridemia” or with cholecalciferol for “vitamin D deficiency.” (To head off any possible outcry: both of the latter conditions surely exist, but evidence for the benefits of treatment is scant.) …