In a stark article in the New England Journal of Medicine, Dr. Gilbert Welch, who has a long history of condemning what can easily be called an epidemic of over-diagnosis in the US, especially cancer over-diagnosis, has taken on dermatologists for what he calls an epidemic of over-diagnosis of melanoma, theoretically the worst form of skin cancer.
Why does Welch suggest that skin cancer specialists are diagnosing way too many melanomas in the US?
Because although the diagnosis of skin cancer has sky-rocketed over the last decade, the death rate from melanoma has remained quite steady.
Which means that either we have become dramatically much better than we used to be a mere 10 years ago at treating all those melanomas, which is highly unlikely, or we are simply labelling way more skin changes as melanomas than we used to do.
I vote with the 2nd choice, by the way.
There will, of course, be instant blowback for this analysis, but it’s really hard to argue with Welch’s conclusion if you read the studies that Welch uses to back up his opinion.
Now, it’s very unlikely that the situation is quite as bad in Canada because well, because our doctors are not paid the same way as American doctors are – American doctors over-test, over-diagnose, and over-treat because their health care system monetarily promotes that kind of approach.
As ever, follow the money.
That said, it’s never a bad idea when you receive a serious diagnosis to ask lots of questions about how sure the doctors are in that diagnosis.