Dr. H. Gilbert Welch is the author of Less Medicine More Health, one of the most fascinating and important books on medicine I’ve read all year.
The book is extraordinary, and it’s authored by a doctor who is thoughtful and systematic in his analysis of seven false assumptions in modern medicine that enrich drug companies, hospitals and surgeons while actually harming the public.
Below, I’m citing a short section from the book that explains how the cancer industry uses psychological terror to scare women and men into unnecessary cancer treatments.
This is extremely relevant today for two reasons. First, we have the recent indictment and prosecution of Dr. Farid Fata, an oncologist from Detroit, working inside the Karmanos Cancer Center property, who used fear tactics to force thousands of innocent patients into cancer treatments they didn’t need. Dr. Fata is now serving 45 years in federal prison.
Secondly, a colleague of Dr. Fata, a “science” info-terrorist who operated under a false pseudonym for several years but has now been exposed as Dr. David Gorski, is still practicing as a cancer surgeon with Karmanos. Dr. Gorski uses fear, intimidation, deception and other similar tactics to bully both patients and critics. He epitomizes the “psychological terrorism” focus of the entire cancer industry, which uses fear as a weapon against patients. (I have already submitted a detailed list of allegations about Dr. Gorski to the Federal Bureau of Investigations.)
Everything you’re about to read below supports what I’ve already uncovered about the criminal cancer industry in my own investigations. I strongly recommend you get the book yourself and read what else he has to say. In my view, reading Dr. Welch’s book may very well save your life.
From “Less Medicine More Health: 7 Assumptions That Drive Too Much Medical Care
First, to get people interested in screening in the first place we have to get people to worry about the disease we are screening for. The phrase typically used to describe this effort is to “raise awareness.” It’s a nice euphemism — but it really doesn’t describe what needs to be done: some “dis”-ease needs to be introduced into the population. In other words, people need to be scared about dying from the disease; they need to be made to feel more vulnerable.
You may not consider that a harm, but remember health is not simply a state of physical being — it’s also a state of mind. It’s more than a little ironic for a health-care system to scare people about their health, particularly when we know that doing so can adversely affect their health.
I’m not saying we should never purposely scare people — just that we need to carefully pick and choose. Fear is an integral part of antismoking campaigns. That’s appropriate. For those who care about population health, there is nothing more important than reducing the amount of cigarette smoking. There’s not only that twenty-to-thirty-fold increase in the most common cause of cancer death in the United States (lung cancer); there’s also the doubling in the most common cause of death, period (heart disease), and the virtual certainty that smokers will develop some difficulty breathing if they live long enough. Aside from scaring people, there’s no harm to the proposed intervention: stop smoking or, more importantly, don’t start.
But fear can backfire — and breast cancer screening is the poster child for the problem. Some women have been made so terrified of the disease, that they are having healthy breasts removed. I’m not referring to Angelina Jolie’s decision to have both breasts (and ovaries) removed — she had a rare mutation that dramatically increases the risk of breast and ovarian cancer. I’m referring to women without the mutation, women at average risk for breast cancer. In the United States (and the United Kingdom), about one-quarter of women who develop breast cancer in one breast now ask for both to be removed. A few — to emphasize, a very few — will die from that decision. The thirty-day mortality rate from mastectomy is about a quarter of 1 percent. They will have been literally scared to death.
There is an enormous climate of fear, whether that’s from Breast Cancer Awareness Month or the news media the other 11 months of the year. The only thing you ever hear about breast cancer is about some woman who’s dying because she didn’t get treated in time.
That’s not me talking, that’s a breast cancer surgeon — the chief of the Breast Service at Memorial Sloane Kettering. She’s worried about scaring women too much.
It is certainly reasonable to ask the question: To what extent should the health-care system be promoting a sense of vulnerability in people who feel well?
SCREENING HARMS — FALSE ALARMS
Second, come back to how the odds are stacked against screening: many (often thousands) must be tested, to potentially benefit a few. Any harms from the testing process — false alarms, complications of diagnostic procedures, etc. — are multiplied since so many people are going through it.
Once again, breast cancer screening is the poster child for the problem. What is most certain about screening mammography in the United States is that it leads to a lot of false alarms: worrisome mammograms, and yet subsequent testing — another mammogram, an ultrasound, an MRI, and/or a biopsy — ultimately finds no cancer. For example, among 1,000 American women age fifty screened annually for a decade, how many will have at least one false alarm? Somewhere between 490 and 670. And 70 to 100 will be biopsied to prove they don’t have cancer. These data come from the mammographers themselves — the Breast Cancer Surveillance Consortium — and reflect radiologists with low and high false-alarm rates (25th and 75th percentiles).
A screening program that alarms half the population is outrageous. No European country would tolerate it. Whether you blame the doctors or the system or the malpractice lawyers — it’s a problem to be fixed. Reducing false alarms is the primary motivation for changing recommendations from annual to biennial screening.
I can’t really do justice to the topic of false alarms following mammography. But the affected women can. When I have a piece pointing out the limitations of mammography in the general press, I get letters like this:
I am a 66-year-old woman who has had a difficult experience with mammography over the past 20 or so years. For some reason, I have a strong tendency to develop calcifications, most of which they feel the necessity to biopsy. I dread every annual mammogram because the likelihood is very high that something will have to be checked out. So far nothing has been wrong, but I have had one open biopsy and three stereotactic biopsies. The last of those biopsies produced an incidental finding of a papilloma, which they decided to do a “lumpectomy” on because one in ten can hide cancer. The surgery did not go well; they informed me they missed the spot and would have to redo the surgery.
Two days later, they decided they had indeed operated on the right area and that there was no cancer in the papilloma. No cancer, but extreme trauma to the patient and a developing panic problem with regard to the whole issue for which I will now be seeing a psychologist.
Or e-mails like this:
I am a PhD in economics and was able to read the medical literature on the usefulness of biopsies when mammography shows the breast conditions that mine did. I concluded that it was extremely unlikely that I had cancer and, because of illness my husband was facing at the time, I wished to at least postpone the biopsy, but I could not find any support for this decision. All the doctors and nurses I talked with were almost hysterical at the idea that I would not have the biopsy, acting as though I was giving myself a death sentence. “It’s no big deal,” they said, “non-invasive.” “Nobody gets a second opinion for a biopsy.” One of the authors of the most illuminating article I’d seen actually practices in my area and so I thought I’d be able to get support from her.
But it turned out to be impossible to consult with her without making an appointment for a biopsy(I).
When I got there, it was like an assembly line. I was stripped and paper-gowned and sent to a waiting room with several other women who were ahead of me. It was obvious that the doctor was someone who had discovered the profit motive since her more-philosophical days when she’d written the article. She said, “Well, probably the best reason to go ahead with the biopsy is that you are here.” I don’t know why I succumbed at that point, maybe just exhaustion from having to take on the entire medical profession single-handed.
The procedure did not go well; the granules she was looking for were so small that she couldn’t find them on the first or second pass. And sticking a 1/2″ needle through my breast seemed pretty “invasive” to me. Immediately afterward, they had me get another mammogram which squeezed the band-aid off the wound and caused blood to squirt out. Because of the difficulty in finding the material to biopsy, my breast was bruised badly for weeks on the side opposite where the needle had entered. I used to be someone who went bra-less a good deal of the time, but for the next 5 years, I almost always wore an athletic bra that held my breasts tight against my chest. When the doctor called to tell me the biopsy was negative, she seemed completely unaware of the irony when I said, “Yes, we knew that would be the case, remember?” Since I never want to be in that vulnerable situation again, I have not had another mammogram.
I think the screening culture has had a tendency to downplay the problem of false alarms — even trivialize the discomfort and anxiety by juxtaposing it with the need to “save lives.” But it matters. Maybe it goes without saying: fear and pain is not good for human health. Medical care needs to work on reducing psychological stress — not creating it.
A number of women have told me they stopped mammography because they got so tired, frustrated, scared, or angry about false alarms. And recent research has documented that the psychological effects — anxiety, negative impact on sexuality and sleep, loss of inner calm — persist for at least three years following a false alarm. Of course, it doesn’t affect every woman the same way. Some may initially fear for their life only to be told a few days later that everything is fine. They are thankful and may even feel that the experience has given them some important new perspective on life. Others are left in limbo. While told they don’t have cancer, they are not told that everything is fine. Instead they learn their breasts are somehow abnormal — that they have dysplasia or atypia, that they are at “high risk” — and can only worry because the doctors aren’t doing anything about it. Nothing, except more mammograms.
* * *