Gilbert H. Welch, MD, MPH
General internist and Professor of Medicine
Dartmouth Institute for Health Policy and Clinical Practice
Geisel School of Medicine
Professor of Public Policy, Dartmouth College
Professor of Business Administration, Amos Tuck School
12:30 p.m. (Lunch Speaker)
Friday, June 24, 2022
International Academy of Endodontics, Annual Meeting
The Scottsdale Princess
Scottsdale, Arizona, USA
"The crazy confluence of Congress, liquid biopsies, Medicare, and health inequities"
A raucous romp through the misplaced enthusiasm for screening liquid biopsies — a single blood test that screens for multiple cancers at once. Mandating Medicare coverage for these unproven, expensive tests somehow produces bipartisanship in Congress (that’s rare) – and proponents assert that multi-cancer screening will somehow address health disparities (that’s rich). The science is thin, yet the financial community is ecstatic: “Liquid Biopsy: Early Detection of a Huge Investment Opportunity”, touts one headline.
Learning Objectives:
- Explain why high survival rates for those with early-stage cancers (and low survival rates for those with late-stage cancers) are NOT evidence that screening will save lives.
- Articulate why liquid biopsies would be expected to be more sensitive for late-stage cancers than early-stage cancers.
- Develop a "healthy skepticism" for liquid biopsy cancer screening by understanding the certain harms and the absence of evidence that it helps people live longer or feel better.
Affiliations:
Brigham and Women's Hospital, Boston
About the presenter:
Dr. Welch is a general internist who has worked for the US Indian Health Service, the Department of Veterans Affairs, and Dartmouth. Currently, he is a Senior Researcher at the Center for Surgery and Public Health at Brigham & Women’s Hospital in Boston. For over three decades, he has been asking hard questions about his profession. His arguments are frequently counter-intuitive, even heretical, yet have regularly appeared in the country's most prestigious medical journals — Annals of Internal Medicine, Journal of the American Medical Association, the New England Journal of Medicine, and the Journal of the National Cancer Institute — as well as in op-eds in the Los Angeles Times and the New York Times. His most recent book is LESS MEDICINE, MORE HEALTH – 7 Assumptions that Drive Too Much Medical Care.
Dr. Welch questions the assumption that more medical care is always better. His research has focused on the assumption as it relates to diagnosis: that the best strategy to keep people healthy is early diagnosis – and the earlier the better. He has delineated the side effects of this strategy: physicians test too often, treat too aggressively, and tell too many people that they are sick. Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast, and prostate cancer.