Is early detection always the best medicine ?

The Recommended Dose, with Alexandra Barratt

Hosted by acclaimed journalist and health researcher Dr Ray Moynihan, The Recommended Dose tackles the big questions in health and explores the insights, evidence and ideas of extraordinary researchers, thinkers, writers and health professionals from around the globe. The series is produced by Cochrane Australia and co-published with the BMJ.

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Dr Ray Moynihan’s guest has led something of a double life, using both medicine and the media to explore and promote the critical role of evidence in healthcare. Now based at the University of Sydney, Alexandra Barratt‘s journey from clinician to journalist to global advocate for evidence based medicine and shared decision-making is a fascinating one.

Here Alexandra talks with Ray about her varied career and the reasons she’s ended up challenging conventional wisdom. She also talks about her research into the pros and cons of breast cancer screening and questions the widely-accepted idea that early detection is always the best medicine.

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How Do Environmental Laws Protect Fracking Chemicals ?

Fracking and Health : Ask an Expert – with Dusty Horwitt

TEDX conducts brief interviews with leading experts to get answers about health threats posed by unconventional oil and gas operations.
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How can NGOs address health symptoms in fracked communities ?

Fracking and Health : Ask an Expert – with Dr. Beth Weinberger

TEDX conducts brief interviews with leading experts to get answers about health threats posed by unconventional oil and gas operations.
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Diagnostic tests : how to minimise harm

We must develop new diagnostic tests to tackle real health problems, not to generate them

New diagnostic tests: more harm than good, BMJ 2017;358:j3314,
06 January 2016.

Defenders against overdiagnosis, BMJ 2017;358:j3487, 20 July 2017.

Although new diagnostics may advance the time of diagnoses in selected patients, they will increase the frequency of false alarms, overdiagnosis, and overtreatment in others.

Bjorn Hofmann, professor of medical ethics at Norwegian University of Science and Technology, explains how to minimise harm. Press Play > to listen to the recording.

Key messages

  • Innovative technologies and ample venture capital are combining to produce new disease biomarkers and mobile monitoring devices
  • These new diagnostics are technologically advanced but do not automatically provide improvements in clinical care and population health
  • They have the potential to help some but also to increase the frequency of false alarms, overdiagnosis, and overtreatment in others
  • Excessive testing and false alarms may increase healthcare workload and shift clinicians’ focus towards the healthy
  • Misleading feedback at both the population and individual levels tends to favour further market growth
  • Clinicians must provide a strong counterbalance: educating patients, respecting baseline risk, thinking downstream, and expecting misleading feedback

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Testing Medical Treatments : DiEthylStilbestrol

Testing Treatments Interactive, promoting better research for better healthcare

Audio published mid 2016 by Testing Treatments Interactive, promoting better research for better healthcare.

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Sources and more information

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Over 50 years later, DES’ adverse effects continue

Women Exposed to DiEthylStilbestrol In Utero Face Ongoing Risks for Adverse Health Outcomes

October 8th, 2011, NEJM Journal Watch talked with two authors of the reportAdverse Health Outcomes in Women Exposed In Utero to Diethylstilbestrol“.

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Sources and more information

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Medical error is the third leading cause of death in the US

Today in the US there are more medications, diagnoses and procedures than ever ; overtreatment is endemic

Medical error—the third leading cause of death in the US, The BMJ, dx.doi.org/10.1136/bmj.i2139, 03 May 2016.

Medical error is not included on death certificates or in rankings of cause of death.

Martin Makary and Michael Daniel assess its contribution to mortality and call for better reporting.
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Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome, the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning), or a deviation from the process of care that may or may not cause harm to the patient. Patient harm from medical error can occur at the individual or system level. The taxonomy of errors is expanding to better categorize preventable factors and events. We focus on preventable lethal events to highlight the scale of potential for improvement. “…

…Continue reading: Medical error—the third leading cause of death in the US, The BMJ, 03 May 2016. See also the responses.

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How charitable giving is profitable to the pharmaceutical industry

Drug companies won’t support charities if they can’t be sure they’re also helping themselves…

How Big Pharma Uses Charity Programs to Cover for Drug Price Hikes, bloomberg, May 19, 2016.

A billion-dollar system in which charitable giving is profitable for Big Pharma…
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In August 2015, Turing Pharmaceuticals and its then-chief executive, Martin Shkreli, purchased a drug called Daraprim and immediately raised its price more than 5,000 percent. Within days, Turing contacted Patient Services Inc., or PSI, a charity that helps people meet the insurance copayments on costly drugs. Turing wanted PSI to create a fund for patients with toxoplasmosis, a parasitic infection that is most often treated with Daraprim.

Having just made Daraprim much more costly, Turing was now offering to make it more affordable. But this is not a feel-good story. It’s a story about why expensive drugs keep getting more expensive, and how U.S. taxpayers support a billion-dollar system in which charitable giving is, in effect, a very profitable form of investing for drug companies—one that may also be tax-deductible. “…

…Continue reading: How Big Pharma Uses Charity Programs to Cover for Drug Price Hikes, bloomberg, May 19, 2016.

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A quand une individualisation du processus vaccinal?

Il nous faut prendre notre santé en main!

Emission “Secrets d’info” du 1er janvier 2016 sur France inter.
Avec le Docteur Dominique Eraud.

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Cancer screening – does it save lives?

Healthcare providers are encouraged to be frank about the limitations of screening—the harms of screening are certain, but the benefits in overall mortality are not

Why cancer screening has never been shown to “save lives”—and what we can do about it, BMJ 2016;352:h6080,
06 January 2016.

The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad and colleagues argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening.
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