Prevention is better than cure, of course. But now Big Pharma exaggerates, pushing potential patients to carry out as many medical checks as possible, making money from it. And so, those who are really sick have to face very long waiting lists and the State loses money needlessly.
Prevention is better than cure is one of the pillars of modern medicine. But when screening pushes the boundaries of science-proven benefit, the risk isn’t just inefficiency: it’s harm. More and more often, in fact, in the name of prevention taken to the extreme we end up playing into the hands of Big Pharma, constantly looking for new patient-consumers and increasingly inclined to medicalise healthy people, pushing them towards tests which in most cases are useless.
It is a drift that distorts medicine, now bent to a logic of consumption rather than real health protection, and fueled by communication left in the hands of private medical centers that promote increasingly advanced screening (and obviously for a fee), of doctor-gurus who prescribe very expensive supplements to prevent “anything” and of influencers who undergo ultra-sophisticated tests to do check-ups that they don’t need: with the sole aim of recommending them (for a fee) to their followers. From the pillar of prevention we have thus fallen into the great paradox of hyper-preventive medicine: a race for checks that promises safety, but produces over-diagnosis (i.e. the fact that healthy people are diagnosed or attributed with an illness that would not cause them any harm), anxiety and a spiral of useless tests.
A mechanism that weighs on citizens’ pockets, on public health budgets and on the already interminable waiting lists, forcing the National Health Service to manage the consequences of choices born far from real clinical indications. «The fundamental problem of these times we are experiencing is that the term “health prevention” has been completely misrepresented» Maria Rita Gismondo, clinical microbiologist and consultant to the Ministry of Health, tells Panorama. «Today, an asterisk on a blood test value is enough to trigger a real fury: that value is immediately interpreted as the alarm of an illness that is definitely about to arrive, and from there we start with an infinite series of increasingly sophisticated checks and tests, of expenses and obviously of anxiety».
A dog chasing its tail: the clear example is that of the measurement of Psa, i.e. the prostate specific antigen, a substance which is produced by the prostate with the function of thinning the seminal fluid, and whose rise can also be the sign of a tumor. «As soon as the PSA rises a little, panic sets in», continues Gismondo. «At that point the urologist, also for fear of complaints or so as not to “lose” the patient, prescribes increasingly invasive investigations, even going as far as intraprostatic ultrasounds and biopsies, complex tests with the risk of infections or incontinence. All this is performed on healthy patients, when perhaps there was no need.” Yes, because a high Psa does not mean cancer: it could be a simple inflammation or an infection. The rational approach would be to repeat the test after some time. «But today the patient no longer wants to wait», says Gismondo. «He becomes alarmed, he wants the test immediately and perhaps to be able to do it as soon as possible he turns to the private sector. And that’s where someone makes money.”
Then there is the market of influencers, who undergo latest generation MRIs and “deluxe” exams to promote clinics and hospitals: just think of Kim Kardashian and Paris Hilton, who have promoted on their social channels (together they reach 400 million followers) the MRIs of the private Prenuvo clinics, which scan the entire body in half an hour for diseases, even before symptoms appear. The cost of the test is around 3 thousand euros, but if there is no real scientific indication, carrying it out makes no sense. Indeed, the feeling of anxiety that can derive from a doubtful result – or false security – that comes from a comforting test can turn out to be a big risk.
Furthermore, when tests of this type are “pushed” on social networks, people always lie: recent research from the University of Sydney published in Jama has shown that influencers – to promote medical tests among their followers – leverage almost exclusively on fear, in “extremely misleading” ways and without mentioning the potential harm. In 87 percent of the posts examined by the Australian researchers, only the benefits were mentioned, while just 6 percent mentioned overdiagnosis and 68 percent of account holders had financial interests at stake.
The race for extreme hyper-prevention appears, among other things, in Italy, more absurd than ever: because thanks to our Health Service, today we are all able to carry out the right screenings for free at the right age, especially for cancer, without having to look for imaginative, expensive and useless methods. «The objective of screening is to reduce mortality», Giampaolo Tortora, director of the Comprehensive cancer center of the Irccs Policlinico Gemelli in Rome, tells Panorama. «It makes sense when it intercepts a disease at an early stage and, above all, when for that disease there are effective treatments capable of truly modifying the patient’s clinical history. If this step does not exist, we are not faced with an effective screening, but with a diagnostic anticipation that is of little relevance and sometimes causes psychological costs for the patient and economic costs for our health service. I would strongly advise against taking these DIY paths.”
Roads which obviously, however, are strongly pushed by big pharma: just think of the large market of home tests such as the famous “23andme” which a few years ago literally drove Americans crazy, promising to quantify the risk of getting ill thanks to the saliva test. Furthermore, today, precisely in the field of cancer, we are also able to set up personalized prevention plans, based on the genetic profile. Example: women who are carriers of the BRCA 1 and 2 mutation (an alteration that can be detected with a DNA test) are at very high risk of developing breast and ovarian cancer, and in their situation it is advisable to resort to preventive removal of these organs. This is what Angelina Jolie did in 2013, saving herself from the cancer that had already killed her mother and aunt.
Bianca Balti, on the other hand, did not have time to completely avoid the problems: carrier of the same mutation, in 2022 she underwent removal of her breasts, but after two years she discovered ovarian cancer (which she had not yet removed) already in the third stage. Personalization, reasoned screening, common sense and rationality even in the face of (slightly) altered blood test values and no concession to the “fashion” of getting checked every year, for any problem: this should therefore be the strategy to protect our health without falling into the anxiety of tests at all costs. But since there seems to be no limit to human hypochondria, there are those who insist on carrying out really annoying tests every year, tormenting their doctors with requests.
This is the case of colonoscopy. «Today many people suffering from, for example, irritable bowel syndrome, ask to have an endoscopic examination without any indication», explains Professor Silvio Danese, director of the gastroenterology and digestive endoscopy unit of the Irccs San Raffaele Hospital in Milan. «It is up to the common sense and seriousness of the doctor not to carry out these tests. Not so much because of the probability of risk, which today in colonoscopy is truly infinitesimal, but because overcrowding is created and precious resources are taken away from the healthcare system and from those who really need screening and tests.” Because prevention is better than cure, of course: but only when prevention remains medicine, and does not become a market.
