Osteopenia: When Does Decreased Bone Density Become a Disease Requiring Treatment?

Osteoporosis is routinely treated with bisphosphonates to prevent fractures. A new study suggests that osteopenia should be treated too. But questions remain.  DEXA Scanner Measures Bone Mineral Density Bisphosphonate drugs have been shown to increase bone density and prevent fractures in postmenopausal women with osteoporosis (remember Sally Field in those ads for Boniva?) but what

Uncertainty in Medicine

  Medicine is an uncertain business. It is an applied science, applying the results of basic science knowledge and clinical studies to patients who are individuals with differing heredity, environment, and history. It is commonly assumed that modern science-based doctors know what they are doing, but quite often they don’t know for certain. Different doctors

Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid

Screen detection and tumor growth rates. Cancers have different growth rates, which determine their potential to be detected by screening. Tumor A remains microscopic and undetectable by current technology (although more sensitive tests in the future might render it detectable). Tumor Beventually becomes detectable by screening (*), but its growth rate is so slow that it will not

Prostate Cancer Dilemmas: To Test or Not to Test, To Cut or Not to Cut

The issue of PSA screening has been in the news lately. For instance, an article in USA Todayreported the latest recommendations of the US Preventive Services Task Force (USPSTF): doctors should no longer offer the PSA screening test to healthy men, because the associated risks are greater than the benefits. The story was accurate and explained the

Re-thinking the Annual Physical

Please note: the following refers to routine physicals and screening tests in healthy, asymptomatic adults. It does not apply to people who have been diagnosed with diseases, who have any kind of symptoms or signs, or who are at particularly high risk of certain specific diseases. Throughout most of human history, people have consulted doctors

Overdiagnosis

Dr. H. Gilbert Welch has written a new book Over-diagnosed: Making People Sick in the Pursuit of Health, with co-authors Lisa Schwartz and Steven Woloshin.  It identifies a serious problem, debunks medical misconceptions and contains words of wisdom. We are healthier, but we are increasingly being told we are sick. We are labeled with diagnoses that

PSA – To Screen or Not to Screen

The prostate specific antigen. You’ve all heard the dramatic testimonials in the media: “I had a PSA test and they found my prostate cancer early enough to treat it. The test saved my life. You should get tested too.” The subject of screening tests is one that confuses the public. On the surface, it would