Diamandis Eleftherios P
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto M5T 3L9, Ontario, Canada.
BMC Med. 2015 Jan 9;13:5. doi: 10.1186/s12916-014-0239-6.
The Hundred Person Wellness Project is an ambitious pilot undertaking, which aims to intensely monitor 100 individuals over 10 months. Patients with abnormal findings will be treated, in hopes that this early intervention will avoid, or delay, symptomatic disease. Google's "Baseline Study" is of similar scope and will enroll 10,000 people over 2 to 3 years. I here speculate that these approaches will likely not be effective in preventing disease, but instead, lead to unnecessary and potentially harmful interventions. Examples from the cancer screening experience over the last 30 years are provided, which show that intensive testing may uncover indolent disease or incidental findings which, when treated, may cause more harm than good. Additional examples show that aggressive treatments for cancer and other diseases do not always lead to better patient outcomes. I conclude that the recent advances in omics provide us with unprecedented opportunities for high content clinical testing, but such testing should be used with caution to avoid the harmful consequences of over-diagnosis and over-treatment. Despite the detailed rebuttals by Hood and colleagues in another commentary in BMC Medicine, time will show the actual benefits and harms of these ambitious initiatives.
“百人健康项目”是一项雄心勃勃的试点项目，旨在对100个人进行为期10个月的密切监测。有异常检查结果的患者将接受治疗，期望这种早期干预能够避免或延缓出现症状性疾病。谷歌的“基线研究”规模与之类似，将在2至3年内招募10000人。在此我推测，这些方法可能无法有效预防疾病，反而会导致不必要的、可能有害的干预措施。文中给出了过去30年癌症筛查经验的例子，这些例子表明，密集检测可能会发现惰性疾病或偶然发现的情况，而对这些情况进行治疗可能弊大于利。其他例子表明，对癌症和其他疾病进行积极治疗并不总是能带来更好的患者预后。我得出的结论是，组学领域的最新进展为高内涵临床检测提供了前所未有的机会，但这种检测应谨慎使用，以避免过度诊断和过度治疗带来的有害后果。尽管胡德及其同事在《BMC医学》的另一篇评论中进行了详细反驳，但时间将证明这些雄心勃勃的举措的实际利弊。
