If you’ve missed the bizarre Twitter debate between billionaire businessman and Dallas Mavericks owner Mark Cuban versus all the health and medical experts online who cared to engage, it’s worth catching up.
Cuban’s comments are key to understanding one of the most important paradigm shifts going on in American health care: the use of data to create evidence-based screening guidelines to reduce unnecessary, expensive and potentially harmful interventions. Writing about screenings therefore requires understanding both the benefits and the harms of screening.
Cuban tweeted Wednesday afternoon:
1)If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health
— Mark Cuban (@mcuban) April 1, 2015
3) a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics” — Mark Cuban (@mcuban) April 1, 2015
This wasn’t an April Fool’s joke – Cuban was seriously recommending to his 2.8 million followers that getting four blood tests a year, every year, was a smart health decision. Charles Ornstein called him out and later Storifyed the ensuing debate. Other journalists, such as Seema Yasmin, M.D., at The Dallas Morning News, also wrote about how wrong Cuban is.
One of the biggest failings of modern medicine is, in fact, the opposite: testing for too many possibilities and screening too often, thereby leading to the possible harms that can result from false positives or benign positives. In short, less is more, and sometimes ignorance is not only blissful but also wise. That’s why many medical organizations are actually scaling back on their tests and focusing on doing the right tests for the right patients at the right frequency.
At nearly every presentation he gives, HealthNewsReview.org founder Gary Schwitzer quotes British doctor Muir Gray: “All screening programmes do harm; some do good as well.” That harm takes the form of added anxiety, extra healthcare costs and unnecessary interventions that can cause physical harm.
But by asking repeatedly whether blood tests should be eliminated, as though it’s all-or-nothing, Cuban displays how little he understands health care. It’s a confusion shared by millions of other health consumers, as his Twitter feed’s retweets reveal. Further, as Dan Diamond points out, Cuban’s platform means his comments matter, even when he’s not a health expert. No one has suggested eliminating blood tests, of course, but neither does that mean getting them quarterly is a smart health protocol.
This question – how often should a person with a certain risk profile (or lack thereof) get a certain screening for a certain condition – is at the heart of many health care issues (and controversies) at the moment. Consider the outcry over mammogram guidelines and prostate cancer screenings. Currently, similar discussions are occurring regarding certain cervical cancer screenings and prenatal tests.
Screenings should occur as often as the evidence suggests – no more, no less. Medical research data helps expert committees determine how often a particular screening should be done to catch as many positives as possible without tipping the balance toward excessive false positives. False positives lead people to worry more and spend time and money undergoing more tests, often increasingly more invasive.
Patients have come to expect that more tests mean better care, and one role journalists can play in writing about medical studies is to explain how better care often means looking less.