[runtime_blues]

Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-dea... . One explanation is that such cancers are slow-growing and tend to be discovered late in life, so treating them doesn't actually help much, and any benefits are offset by potential harms of the procedure itself, the risk of false positives, etc.

Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. The drugs have health risks: https://jamanetwork.com/journals/jamainternalmedicine/fullar...

There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory.

A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.

[haldujai]

> Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here:

This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1].

With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing.

In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide.

> Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial.

This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting.

For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to:

"In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease."

[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

[1] https://www.uspreventiveservicestaskforce.org/uspstf/documen...

[2] https://www.ahajournals.org/doi/full/10.1161/HYP.00000000000...

[oaktrout]

"This is just boldly incorrect and a VERY dangerous statement to make."

I couldn't agree more. I worry that individuals will read things like the grandparents uninformed take on hypertension and conclude "I guess I don't need to worry about my blood pressure". Be careful what medical knowledge you take away from HN. Imagine forming opinions about software engineering practices by reading a forum filled with medical doctors.