Educated Guesses

Prevention is the best cure - or is it? As medical experts stress the importance of annual check-ups and routine screening, patients have assumed that such tests are essential for saving lives. But just how effective are these tests? Medical economist Louise Russell challenges the standard wisdom that more is better by examining three routinely administered tests in the USA - those designed to detect cervical cancer, prostate cancer, and high cholesterol. What she finds should sharpen today's health-care debates. Recommendations such as annual Pap smears for women and prostate tests for men are simply rules of thumb that ignore individual cases and the trade-offs between escalating costs and early detection, Russell argues. Evidence on the effectiveness of screening tests demonstrates that the actual results are far less beneficial than one might expect. It is not clear, for example, that annual Pap smears for all women over age 18 are any more effective in reducing cervical cancer deaths than testing every three years; nor is there solid evidence for the value of annual prostate cancer screening among men under 50.
The case studies Russell presents raise serious questions about how tests are evaluated, recommendations formed, and medical resources allocated.