Over the past two decades a vast new armamentarium of diagnostictechniques has revolutionized the practice of medicine. Theentire human body can now be imaged in exquisite anatomicaldetail. Computed tomography (CT), magnetic resonance imaging(MRI), and ultrasonography routinely "section" patients intoslices less than a centimeter thick. Abnormalities can be detectedwell before they produce any clinical signs or symptoms. Undoubtedly,these technological advances have enhanced the physician's potentialfor understanding disease and treating patients.
Unfortunately, these technological advances also create confusionthat may ultimately be harmful to patients. Consider the caseof prostate cancer. Although the prevalence . . . [Full Text of this Article]
Prevalence of Disease
Abdominal Aortic Aneurysms
Cancer
Breast Cancer
Therapeutic Effectiveness
Lead-Time Bias
Length Bias
Apparent, Real, and Spurious Effects
The Cycle of Increasing Intervention
Conclusions
Source Information
From the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, N.H. (W.C.B., H.G.W.); the Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H. (W.C.B.); and the Medical Service, Veterans Affairs Hospital, White River Junction, Vt. (H.G.W.).
Address reprint requests to Dr. Black at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, 318 Strausenburgh Hall, Hanover, NH 03755-3863.
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