#616: More Testing, Better Health? Harms of Overdiagnosis & Overtreatment - Austin Baraki, MD

**Danny Lennon** (0:00)
Hello, and welcome to Sigma Nutrition Radio. This is episode 616 of the podcast. My name is Danny Lennon. You are very welcome to the show.
And today, we're going to be talking all about screening and testing from a medical perspective in order to improve health. And oftentimes, medical screening or the use of tests, which more and more we have available to us now, are often framed as this uncomplicated good that there's, if we can detect some type of problem earlier, then we can begin treatment earlier, outcomes would improve, everything is logical.
And of course, there are many cases in which screening programs are really useful. There's a lot of cases where some type of regular testing for health can be potentially useful. But that type of reasoning is also incomplete and misses out a whole other side where we can run into some significant problems. And while screening and testing can of course produce benefit, there's also risk of a number of things from positives, incidental findings, and then some issues that we're going to discuss today, whether to overdiagnosis, over-treatment and diagnostic cascades. And this is something I've been looking at recently. And again, in order to revise over some of this topic and go through some of the literature, one of the things I did was revisit an episode that I actually did a number of years back with Dr. Austin Baraki, who is a fountain of knowledge on these topics and has a perspective that I think will be of significant value to you if you have yet to come across some of these concepts that I've just mentioned. And so what I've gone and done is taken that episode we've gone through and remastered the audio, re-edited it, added study notes that were not previously available for all of you who are premium members. And I wanted to bring back that conversation for you here today, because on re-listening to it and going through the materials that are prepped for that, I have found that there's a whole host of things that I wanted to be reminded of and thought that this would be a particularly good time to re-broadcast that particular interview. And so hopefully you will enjoy this conversation. In the description box for this episode, you will find the episode page, and there I'm going to put a list of further reading that relates to all the things that we mentioned throughout this episode. So if you do find this topic interesting, and you want to drill into it even further, there's a whole list of resources you can go and check out. So that will be linked up in the description box where you're currently listening. If you are listening on the public feed of the podcast, and you want to get those detailed study notes in addition to that, and go through all this material in much more depth, then do consider becoming a Sigma Nutrition Premium Member, where you get detailed study notes to all these episodes, as well as premium exclusive episodes each month as well. And so, I think that will really be an useful adjunct to your learning here. If you are a premium subscriber, then again, go to the description box, and you can find your study notes there, or you can go over to sigmanutrition.com and find that all on the episode page itself, as well as a fully edited transcript. So let's dive into this conversation all around testing, screening, overdiagnosis, over treatment with the excellent Dr. Austin Baraki.
Austin, thanks so much for doing this. Appreciate you taking the time out to do it.

**Austin Baraki** (3:30)
Yeah, no problem. Thanks for having me.

**Danny Lennon** (3:31)
Maybe to start off, if we take the concept of screening, probably a good place to start the discussion, as always, is with some definitions. So how would you define the concept of screening and what is the goal of screening, essentially? Sure.

**Austin Baraki** (3:46)
So the idea of screening is that we're searching for an unidentified condition in people who don't have symptoms already, i.e. what we call asymptomatic individuals. So people who look and seem and feel fine, but we're trying to find evidence of either disease or a risk factor for disease or something like that could potentially increase their risk of down the line developing disease or premature death. And this is important to distinguish from diagnosis. Diagnosis is a situation where somebody shows up with a symptom, and based on that symptom, we launch an investigation to try to find kind of an explanatory process that can then be treated to mitigate their symptoms or risk of progression or death.
So we're looking for people in conditions and people with no symptoms. And this can be applied both very broadly, like across, say, the whole population, that would be like mass screening of the general population, or it can be applied to, like, demographic cohorts. Obviously, there's some things that we only screen women for, or some things that we only screen men for, for example.