An excellent summary of the chequered history of mammography screening trials. Like many other areas of science, cancer medicine is run by those with a vested interest rather than those with an open scientific mind. Peter Gotzsche is one of the latter so he has suffered for not toeing the consensus line. The irony is that those with a closed mind who defend the shoddy science behind the many flawed randomised controlled trials evaluating mammography screening criticise researchers like Peter Gotzsche for having a closed mind, for being biased and for campaigning against mammography screening.
For those like myself who have watched the politics of cancer over the past 30 years there is nothing surprising in this book. But for those who rely on the media for information about cancer screening, they will find much of the contents unbelievable.
The politics of cancer screening is almost identical to that behind the similar controversies of the cholesterol debate in relation to heart disease and the debate about global warming. Many people ask the simple question: How can 95% of the experts be wrong?
Peter Gotzsche's book explains in fine detail how the majority of so called experts apparently don't understand the basic principles of how to run, and how to interpret the results of a randomised controlled trial.
What is shown in this book probably also applies to all of the other types of cancer screening that have been evaluated using randomised controlled trials: screening for prostate, lung, bowel and ovarian cancers. In none of these areas has there been any clear evidence that earlier surgery made possible by screening has produced any saving of lives. Yet In all of these areas the experts have been promoting cancer screening in their area after misunderstanding the results of these trials.
The only shortcoming I found in this excellent book is the author's failure to grasp the significance of his findings: screening doesn't help people with cancer because cancer is a systemic disease. If tumours are only symptoms of a systemic disease, it is not surprising that surgery doesn't help, or that earlier surgery made possible by screening also doesn't help. It in fact causes more harm than good.
Gilbert Welch's excellent book "Overdiagnosed: making people sick in the pursuit of health" shows how screening and other testing often causes more harm than good by finding symptoms that would not have led to death if left alone.
With these two books we are at last getting some of the nitty gritty behind the findings in the earlier ground-breaking books such as Ivan Illich's "Medical Nemesis (1975), Richard Taylor's "Medicine Out of Control" (1979) and more recently Ray Moynihan's "Too much medicine" (1998).
However none of these authors hs concluded from the lack of progress with cancer over the past 70 years that the reason is the unproven assumption that cancer starts locally and later spreads.
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Lorraine Evenden
A very important book, and I believe he's essentially ...
Reviewed in the United Kingdom 🇬🇧 on August 26, 2014Helen MacAllister
It makes sense
Reviewed in the United Kingdom 🇬🇧 on March 6, 2014
