Feedback: commercially driven healthcare screening in Malaysia
Dr. Lum writes in
I am a Malaysian who is currently practicing in US. I like the MMR website but I am not a blogger. I would like to hear some feedback from you (or your fellows) regarding the unethical and commercial driven healthcare screening in Malaysia. I have enclosed some links.
1. Bias and misleading:
“As a medical practitioner, I was taught in medical school that only few tumour markers are really useful i.e PSA, AFP and CEA, and most of the tumour markers are used for monitoring of disease status rather than screening. I am sure a lot of doctors also share this belief.
However, after a few years working with BP Healthcare Group, I now realize that tumour markers are not as useless as most doctors think they are. Let me share with you two case scenarios which happen to my patients and, hopefully with that, you can decide for yourself whether checking tumour markers are really necessary in health screening” source
2. Commercial driven healthcare screening – ridiculous screening tests, it seems that the Malaysian Health Department is supporting these types of screening.
source b (look at page 2)
source c (support from Malaysian Health Department?)
3. From Singapore Health Promotion Board (HPB) Feb 2011
4. From Journal of Clinical Oncology Feb 2012 (electronic) May 2012 (paper)
“Professional society guidelines and the US Preventive Services Task Force (USPSTF) review and integrate clinical study data to determine whether various tests have evidence-based utility in various situations.7,8 Low specificity of testing leads to high false-positive rates, which then promotes dangerous and unwarranted follow-up testing, treatment, patient labeling, and patient anxiety. Conversely, low sensitivity of testing leads to high false-negative rates, which then results in missed diagnosis and delayed care. Under these circumstances, evidence-based guidelines usually recommend against test use for general population screening. When applied to online DTC cancer screening, as outlined in Table 2, evidence-based guidelines either recommend against general population screening or make no recommendation for every DTC tumor marker identified in this study.
Legally, because these online advertisements for DTC cancer screening tests are potentially false and misleading, the FDA is empowered with the Department of Justice to file for temporary restraining orders in abbreviated ex parte hearings (ie, hearings with only one side present) to have Web sites stop these potential violations of the Food, Drug, and Cosmetic Act.19
Journal of Clinical Oncology (Feb 2012)
I hope the MMA and Malaysian Health Department will start regulating
these types of healthcare screening. Hope to hear from you (and your
Wen Sun Lum, MD
Memorial Hospital South Bend, IN and
Volunteer Clinical Assistant Professor
Indiana University, School of Medicine (South Bend)