As personalized medicine and preventative screenings become increasingly prevalent-and marketed-a critical debate is emerging regarding the value of “more” healthcare. A new book by Italian medical journalist Roberta Villa,”Cattiva prevenzione. I pericoli del consumismo sanitario” (Bad Prevention. The Dangers of Health Consumerism),challenges the notion that increased medical intervention automatically equates to improved health,arguing that a focus on early detection without effective treatment can be harmful and divert resources from genuinely needed care. Villa’s work underscores the need for a more discerning approach to preventative health, prioritizing evidence-based strategies over anxiety-driven testing.
The pursuit of perfect health through endless testing, check-ups, genetic screenings, and a constant stream of supplements and medications is increasingly common. Fueled by influencers and public figures promoting generic “prevention,” many believe that more medical intervention equates to better health – especially for those who can afford it. However, experts caution that this approach is often misguided and potentially harmful, highlighting the importance of a more nuanced understanding of preventative care.
The core issue, according to medical journalist Roberta Villa in her book “Cattiva prevenzione. I pericoli del consumismo sanitario” (Bad Prevention. The Dangers of Health Consumerism), is the flawed assumption that spending more money automatically leads to better health outcomes. “There’s a tendency to think that the more money an individual or the healthcare system is willing to spend, the better the result will be,” Villa explains. “This is true to a certain extent, but once necessary or useful services are guaranteed, the correlation between investment and quality doesn’t continue to produce value in a linear way.”
Effective prevention requires a careful evaluation of probabilities and risks, a skill that is often lacking. There are inherent limitations to preventative measures – achieving zero risk is impossible – and significant human, structural, and economic costs to consider, given limited resources. Preventative strategies must be tailored to age, geographic location, and the specific healthcare system in place. Prioritizing modifiable risk factors while accepting those that are beyond control – such as genetics, age, and sex – is crucial.
Prevention is Effective When Treatment Exists
Villa’s work examines the dangers of both “overdiagnosis” – identifying conditions that will never cause harm or death – and “overtreatment” – aggressively treating slow-growing cancers like ductal carcinoma in situ breast cancer, small lung nodules, or prostate cancer, exposing patients to unnecessary side effects. A fundamental principle of effective prevention and mass screenings is that tests should only be conducted if the results will lead to interventions that improve a person’s quality or length of life. This raises questions about the value of early diagnosis for conditions like Alzheimer’s disease when there are currently no curative therapies.
Furthermore, resources spent on unnecessary tests are diverted from those who genuinely need them, even if those tests are paid for privately. The book highlights that truly necessary preventative screenings are surprisingly limited, primarily including cancer screenings for breast and cervical cancer in women, and colorectal cancer for all genders. While participation rates are increasing for the first two, colorectal cancer screening remains significantly lower, particularly in southern Italy.
Full-Body Scans: Unnecessary and Potentially Harmful
The demand for new preventative measures is often driven by anxiety rather than evidence. For example, screening the entire population for pancreatic cancer would be ineffective – unless individuals are already at high risk – because the disease progresses so rapidly that frequent testing would be required. Similarly, lung cancer screening with spiral CT scans is only beneficial for heavy smokers. Concerns have also been raised about mass screenings for diabetes and celiac disease in children, while vaccinations – such as those for hepatitis B and human papillomavirus (HPV) – are considered “good” prevention.
The routine use of electrocardiograms (ECGs) for all children participating in sports is also debated, as it may not accurately identify those at risk of sudden cardiac death and could discourage participation. For adults, the widespread use of ultrasound of the supra-aortic trunks or transvaginal ultrasound for women is questioned unless there is a specific risk factor. The same applies to prostate-specific antigen (PSA) testing, which, if extended to all men, would likely lead to a significant increase in overdiagnosis.
Villa also criticizes the growing popularity of do-it-yourself genetic tests, as well as the obsessive use of smartwatches and continuous glucose monitors. Annual check-ups, including full-body scans, are particularly scrutinized as being ineffective and even harmful for healthy individuals, potentially leading them to ignore subsequent symptoms. However, these scans can be crucial for detecting hidden metastases in cancer patients.
Ultimately, Villa argues that focusing on lifestyle factors that prevent or delay disease – such as addressing obesity, physical inactivity, smoking, excessive alcohol consumption, and promoting education and social connection – is more effective. She also points out that the health industry itself contributes to pollution through emissions, waste, and energy consumption. Addressing these broader environmental and social determinants of health may be more impactful than multiplying expensive, anxiety-inducing, and ultimately unnecessary tests.
