6_Selling Sickness - Moynihan (1)

6_Selling Sickness - Moynihan (1) - Education and debate...

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ing appointments, as if it were a civic duty. In leaflets, women get simple messages—that cancer detected early can be cured, and early cancers can often be treated with breast conserving surgery. The data tell another story: no reliable evidence shows that breast screening saves lives; breast screening leads to more surgery, including more mastectomies; and estimates show that more than a tenth of healthy women who attend a breast screening programme experience con- siderable psychological distress for many months. 34 Senior scientists argue that this debate should not be taking place in public. 5 This misguided paternalism makes us wonder why health professionals are so eager to intervene in healthy people’s lives and about those people’s own perspectives on risks. In Denmark, the most common cause of death from cancer among women is no longer breast cancer but is now lung cancer, which is mainly self inflicted. It seems that every person aims to balance the rewards of taking risks against perceived hazards. 6 This can probably explain why laws on wearing safety belts have not reduced deaths from road crashes. Such deaths now happen to those outside rather than inside the vehicle—probably because drivers who wear safety belts feel safer and drive faster or more carelessly than those who do not. 6 Another important consideration is the reliability of studies of risk. Increased risks are often reported in case-control studies, which do not reliably identify moderate increases in risk. A much quoted and carefully done meta-analysis of case-control studies claimed to show a 30% increase in the risk of breast
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