Fatalistic thinking

[median]

I don't know if anyone caught today's Loose Women programme (I just popped home for lunch and it was on, honest :-[)

A point of discussion was cervical smear testing and screening for diseases in general.
One of the contributers made it clear that she would rather not know if she was ill (and supported this argument citing the loss of quality of life for her mother when she was diagnosed in the latter stages??)

Needless to say that I was somewhat perplexed with this response. ???
The attitude seems to be a good example of peoples fatalistic thinking. Indeed, a further illustration would be people's reluctance to carry donor cards with the idea that this might somehow 'tempt fate'

It is interesting to note that despite evidence that clearly presents a link between early diagnosis of some cancers and increased recovery rates, that this type of thinking goes on. :o

[Dr B]

I bet john has a full fallacy name for this and has probably written a commentary on it ;D

Cue 'Dodgy John' :eek:

[Dr B]

Have you ever heard the one about not using easy-start spray on your cars because it gets addicted to it ;D

I use to hear this all the time. Of course, it was merely the original problem (that needed the easy start) getting worse and worse. Engines cannot get addicted as far as i know :D

you can see how the reasoning links the use of a substance, to an increased dependence on it, but due to a completely independent factor (the original fault getting worse). Ok tangent over O0

[Araneus]

I don't think it is fatalistic so much as "head in the sand" thinking. Some people would genuinely rather live in a state of blissful ignorance than be burdened with the truth.

[Cuddles]

I don't think this is fatalistic thinking, so much as it is simply one excuse of many for the test not to be taken. http://news.bbc.co.uk/1/hi/health/6286095.stm As this link shows, there is a steady decrease in the number of of women having screening tests. The focus here is on cevical screening, but the same seems to be true for breast screening as well. There are many excuses people use for this, none of which are actually valid. The annoying thing isn't that they refuse to be tested, since I would regard that as their own fault if they get ill, but that if they do get ill they blame the screeners for not finding out earlier and the doctors for not being able to treat it. My mother works in the Welsh screening services, and there are always several court cases under way, most of which consist of someone saying "I haven't turned up to a screening appointment for the last 15 years and now I'm ill. Give me some money.", and these are the cases that aren't dismissed out of hand. Whatever the excuse used, it seems most peope simply refuse to take responsibility for their own health, and when something goes wrong they still won't blame themselves but instead lash out at those who were trying to help them all along.

[Admin]

A point of discussion was cervical smear testing and screening for diseases in general.
One of the contributers made it clear that she would rather not know if she was ill (and supported this argument citing the loss of quality of life for her mother when she was diagnosed in the latter stages??)


I think that sort of thinking is basically down to fear although it's not always illogical.

Cancer screening is only of any benefit if the cancer is potentially treatable. A problem with screening is that if a person has a terminal cancer, they know about it for a lot longer than if they went unscreened. They die at the same time but their quality of life is reduced because they live with the knowledge that they are going to die for longer.

It can be argued that life is prolonged with early detection but this may be illusory. i.e. if people who are screened for cancer live an extra year from diagnosis compared to those who don't, it may simply be because their diagnosis was made a year earlier and not because they live any longer.

This is at the heart of the breast cancer screening debate. Some cancers will prove fatal even with relatively early detection whilst others are curable even with relatively late detection. It's more about the type of cancer than the detection time; thus breast screening may be very ineffective.

If screening is proven to be effective, then we should always use it. If it has little to no value in improving prognoses then I can understand people not using it and indeed actively avoiding it.

[Araneus]

Perhaps the output from the screening process from the patient's point of view should be one of two options:

1. You have a treatable cancer.
2. You do not have any treatable cancers.

Option 2, of course, could apply both to "no cancer" and "untreatable cancer". This would probably be difficult to implement, because there are no doubt many cancers whose treatability is not determined until you try it.

[median]

Cancer screening is only of any benefit if the cancer is potentially treatable. A problem with screening is that if a person has a terminal cancer, they know about it for a lot longer than if they went unscreened. They die at the same time but their quality of life is reduced because they live with the knowledge that they are going to die for longer.

Alternatively, a person who knows their projected lifespan has greater scope to make terminal arrangements (will, estate etc)


It can be argued that life is prolonged with early detection but this may be illusory. i.e. if people who are screened for cancer live an extra year from diagnosis compared to those who don't, it may simply be because their diagnosis was made a year earlier and not because they live any longer.

This is at the heart of the breast cancer screening debate. Some cancers will prove fatal even with relatively early detection whilst others are curable even with relatively late detection. It's more about the type of cancer than the detection time; thus breast screening may be very ineffective.

The fact is that the research suggests that with a majority of cancers, detection at an early stage will provide a greater chance of survival


If screening is proven to be effective, then we should always use it. If it has little to no value in improving prognoses then I can understand people not using it and indeed actively avoiding it.

Whilst I see your point, John, it should be noted that oncology research is a vast area and improvements are being made all the time. As you could probably appreciate a present state of knowledge is not a static entity. Therefore, unless you really have up-to-date information, a person may be making an ill-informed choice.

[tkingdoll]

Before going for my recent breast scans, I made the mistake of doing some online research (any women reading this: if you find a lump, DO NOT go and google!) and came across an article which suggested that (ho hum) breast screening may actually trigger cancer in some cases.

And for a brief moment, I considered not going.

Thankfully, I'm smarter than that, but it was a big article (BBC I think) and that may well be having an effect. I can well imagine women avoiding a screening if they don't have any lumps or other problems. It's an invasive procedure (esp. a smear test, ew) and 99.9% of the time the results are negative.

However, having been through the blase mill on this particular subject, I know you can never say never.

What is interesting is that the mammogram didn't actually show my lump. The MRI did, but it was too deep in the tissue to be caught by the weird old contraption they x-ray you with.

[Mojo]

Before going for my recent breast scans, I made the mistake of doing some online research (any women reading this: if you find a lump, DO NOT go and google!) and came across an article which suggested that (ho hum) breast screening may actually trigger cancer in some cases.

And for a brief moment, I considered not going.

Thankfully, I'm smarter than that, but it was a big article (BBC I think) and that may well be having an effect. I can well imagine women avoiding a screening if they don't have any lumps or other problems. It's an invasive procedure (esp. a smear test, ew) and 99.9% of the time the results are negative.

This is a bit like reporting bias - one story gives a particular slant on the situation, and on seeing it people tend to have an "oh my God" moment and disregard the many articles saying that early detection via scans is a rather good thing (John probably knows a name for the fallacy). There's something a bit like this in Steven J. Gould's the median is not the message, where he describes researching mesothelioma after he was diagnosed with it and being frightened by what he found before actually thinking about how he personally fitted into the picture (as far a I remember, mesothelioma has a median survival of something like six months after diagnosis, but this is partly because a lot of cases are not diagnosed until late; Gould's was diagnosed early, and he was a lot younger than most people diagnosed). The Gould essay is worth showing to anyone who has been diagnosed with a potentially terminal disease. A friend of mine was last year diagnosed with what is generally a rather intractable type of lymphoma, and was given a median survival of two years. Like most people told this sort of thing he leapt to the conclusion that this meant that he had two years to live, and was planning to sell his flat and spend the proceeds in the time he had left. After reading the Gould essay he realised that, like Gould, there were several factors that meant that he was probably not going to be near the median. Thanks to the marvels of modern medicine, he has recently been given, well, not an all-clear, but as near to one as he's likely to get; apparently the cancer cells are at an undetectable level.

[Cuddles]

Whilst I see your point, John, it should be noted that oncology research is a vast area and improvements are being made all the time. As you could probably appreciate a present state of knowledge is not a static entity. Therefore, unless you really have up-to-date information, a person may be making an ill-informed choice.

I think this is an important point. While there are any number of anecdotes and newspaper articles about how screening might not work, all the people actually working in the area say it does work, and when it comes down to it, they're the ones that should know.

Another interesting point is that while many people say they would rather not know, if they actually do get cancer they almost invariably wish it had been found earlier, curable or not. Rather than asking the general public how they think they would feel, it is much more important to ask those who actually know how they feel.

[Zaira]

A couple of little points to consider here…

Older people would prefer to live in ignorance of all the things that might be wrong with them. There is the odd aches and pains but so long as there is no serious problems it’s a case of if it aint broke don’t fix it.

And younger people are sick of the length of time they have to wait to be seen and the length of time they have to wait for results, in the time it takes to get the results they could have made themselves sick with worry.

And in a lot of cases small ops are being done unnecessarily.

Also there is not much faith in lab technicians - they make too many mistakes.

It’s like doing a full body scan, no matter how healthy you are it will pick up on something in every single person. You are more likely to become ill while having this something treated than you are by the something.

Even if you disagree with me, all I’m saying is there are people who think like this and perhaps that is why the number of people coming forward to be tested is dropping.

And I don’t believe it is fatalistic thinking. Quite simply people are pissed off with the way things are done and with the way they are treated.