Screening for diapers
John Ioannidis has been very successful in pointing out what had been hidden in plain sight: we should assume that many— if not most— publications about therapy, including RCTs, are wrong. Here he shows his pen can muster a lovely turn of phrase. He is reviewing ‘Seeking Sickness’ by Alan Cassels in Lancet Oncology.
The book offers a wealth of anecdotes about the complex forces that try to promote unnecessary screening. Some of the suspects are already well known: manufacturers of screening tests and technology; drug companies that promote screening to sell their products; lofty academic opinion leaders with industry ties who sell sickness; medical specialists who profit personally from doing more tests, procedures, operations, and follow-up visits; and advocacy groups with questionable allegiances. But this is such a strange world that some influential players are more difficult to imagine. So, by reading Cassels’ book, you will find out about the Oprah effect—ie, why a good word about a screening test by Oprah Winfrey can beat any sophisticated meta-analysis. Or, you will realise that the staunchest supporters of the use of the prostate-specific-antigen test for prostate-cancer screening include not just urologists and radiation therapists, but also manufacturers of diapers. It is amazing how many people make money out of the misguided hunt for disease.
And no doubt the data miners at the supermarkets and Amazon already have the diaper habits included in their algorithms.