I pedal my exercise bike five days/week. I work up a sweat when I pedal that thing. You can bet your bottom dollar I’m going to wash up.
Steve
Somewhat more seriously… there is an entire book about medical procedures, surgeries, medications and devices that have been used for decades (some over a century) that prove to be useless or even harmful when tested in double-blind, multi-center studies.
Everyone should read this book.
Everyone should also be aware of thennt.com, which publishes evidence-based medicine. “The NNT” stands for “number needed to treat” to get the desired response from a medical intervention. The NNT uses a color code (green, yellow, red and black) to categorize interventions. Black stands for interventions that cause more harm than good. Prostate Specific Antigen (PSA) Test to Screen for Prostate Cancer is rated “black.”
PSA Test to Screen for Prostate Cancer – TheNNT
Conversely, cranberry products were rated green for treating UTIs since 1 in 16 women with recurrent UTIs were helped while none were harmed. Note that 1 in 16 is the NNT (number needed to treat) to get this result.
https://thennt.com/nnt/cranberry-products-for-preventing-urinary-tract-infections/
Aspirin to Prevent a First Heart Attack or Stroke is rated red on the basis of significant risk of harm while Aspirin to Prevent Cardiovascular Disease in Patients with Known Heart Disease or Strokes is rated green since the benefits outweighed the harms.
https://thennt.com/nnt/aspirin-to-prevent-a-first-heart-attack-or-stroke-2/
https://thennt.com/nnt/aspirin-for-cardiovascular-prevention-after-prior-heart-attack-or-stroke/
Wendy
Well, you can take the test, and then carefully evaluate your options to see what intervention is required, if any. While most prostate cancers are slow growing and you’ll likely die of something else, a few are more aggressive – you’d want to catch those with the screening.
It’s the intervention that’s the problem, not the screening test.
intercst
…and a lot of PSA positives indicate, as they did for me (did twice) absolutely Nothing except that my prostate seems to like to make it.
However, it’s good to be aware that, when things change with evolving evidence in healthcare, sometimes “reversals” are reversed. I doubt we’ll see routine stenting again for asymptomatic coronary artery disease, or the laying on of Royal hands for scrofula (tuberculous lumph nodes in the neck) etc but aspirin as a recommendations to prevent a first heart attack or stroke has not been thrown out with the bathwater.
Since 2009 (when the early NNT example dates from) advances in technology and discovery in the pathophysiology of ASCVD has enabled the identification of those with the level of heart disease to put them on the fast track for that first heart attack/stroke before the crushing chest pain and either sudden cardiac death or recovery with lasting disability as the diagnostic.
@VeeEnn the ratings of the recommendation to take aspirin for people with heart problems (green) with the recommendation to avoid a daily prophylactic aspirin for those with NO indication of heart problems (black) show that the “green” group has a significant incidence of harmful bleeding. It’s just that the benefit outweighs the risk.
They assume that a person’s doctor/ cardiologist will evaluate the specific situation. A person who is on the fast track for that first heart attack/stroke is not in the same category as someone with low risk and will probably be put on aspirin therapy.
My cardiologist has prescribed a daily aspirin for me even though my coronary arteries are clear. I assume it’s to prevent clots on my new aortic valve.
Wendy
Yes indeed. However, and as I pointed out, the recommendations from this particular site are based upon old data from studies that looked at the sort of criteria that went for standard of care at primary care level close to 20 years ago…and hasn’t changed much for a good many in the intervening years.
Here you go, from the site…
Study subjects were selected on the basis of high blood pressure, dyslipidemia and diabetes (presumably T2D) There are no further details of selection criteria, but I’ll wager the dyslipidemia was determined by total cholesterol and LDL-C back when these patients were first recruited. Good enough for a superficial screening but probably all that was used to determine risk. No advanced particle testing or CAC scan to assess for actual coronary artery disease/heart problems. Pretty much the sort of stats that’re used in the old (outdated?) ASCVD risk calculator. The risk calculator that had me with my “mildly elevated” LDL-C at a low risk of cardiovascular event.