Testing, testing

Amanda Schaffer, who is smart and writes well (and is apparently an M.D., not that this is necessarily a contradiction) says what every epidemiologist has been thinking about one of today's medical trends: over-screening for a host of maladies. One thing she doesn't discuss in detail, though she does mention it, is the controversy over prostate-cancer screening and PSA.

Over at the New Yorker, Dan Baum's article "The Price of Valor" [not available on-line] examines the mental price paid by soldiers for doing their job: killing the enemy. He convincingly shows the need for a thorough study of psychological problems due to killing enemy combatants, and, in a feat of terminological avoidance, he does it all without once using the word epidemiology.

One comment on the article. Baum cites figures showing that the rate of suicide among active-duty servicemen is lower than among the general population, and ascribes this to the fact that "it's difficult for a soldier to be a loner" (I'm paraphrasing). I think this difference is more likely due to something epidemiologists call the healthy worker effect (HWE) -- people with a steady job tend to have lower rates of most diseases than do the (non-employed) general population, because the chronically ill and disabled tend to be screened out of the employment pool. The same is even more true of soldiers.

This raises some interesting questions about psychological sequelae among active-duty servicemen, and whether there is an HWE for mental health among those in the military. Hey, that's a journal-club topic. (I don't mean this, though it seems interesting.)