Of particular note here is whole-body screening with CT and screening for cardiovascular and cerebrovascular disease with ultrasound. On the one hand, one might say that the latter is harmless, involves no ionizing radiation, and may identify individuals at risk of heart attack or stroke—except that we have no idea what to do with this information. There are no data, for example, attesting to the value of carotid vascular stenting in the asymptomatic patient with a carotid stenosis.

For whole-body CT, the evidence for risk benefit is even more tenuous. In the U.S., the total population radiation dose provided by CT may be responsible for up to 2% of all cancers. If you explain that to the worried, well! How many would still be queuing for their whole-body scan? Probably still enough, to continue to contribute to imaging as a growth industry.

It is important to develop greater honesty and completeness in the presentation of information to individuals about all screening methods. We may be convinced of the value of the test and passionate about its life-saving potential, but we must not use our scientific fervor to influence our patients' choice inappropriately. We must present adverse data as well, even if it discourages some from choosing to be screened and even if this negates the very evidence that supports the introduction of screening.

Individual choice will still depend in part on personal experience and on anxiety, prejudice, and misconception. Like my own, choices will be based at least partly on the selection of data that I choose to believe: smoking is evil (I never have!), alcohol is good in moderation (I do), and occasional workouts in the gym confer the same level of longevity as regular exercise.

And screening? Until they develop a method for screening the prostate that does not involve needle biopsy, I'll pass.