Cancer screening - principles, evaluation and implementation

Screening for malignant disease aims to reduce the population risk of impaired health due to the tumor in question. Screening does not only entail testing but covers all steps required to achieve the intended reduction in risk, from the appropriate information of the population to a suitable therapy. Screening tests are performed in individuals free or unaware of any symptoms associated with the tumor. An essential condition is a recognizable pathological abnormality, which occurs without symptoms and represents a pre-clinical, early stage of the tumor. Overdiagnosis and overtreatment have only recently been recognized as important problems of screening for malignant disease. Overdiagnosis is defined as a screening-detected tumor that would never have led to symptoms. In prostate-specific antigen (PSA) screening for prostate cancer 50 % - 70 % of screening-detected cancers represent such overdiagnoses. Similarly, in the case of mammography screening 20 % - 30 % of screening-detected breast cancers are overdiagnoses. The evaluation of screening interventions is often affected by biases such as healthy screenee effects or length and lead time bias. Randomized controlled trials are therefore needed to examine the efficacy and effectiveness of screening interventions and to define the rate of adverse outcomes such as unnecessary diagnostic evaluations, overdiagnosis and overtreatment. Unfortunately there is no independent Swiss body comparable to the National Screening Committee in the United Kingdom or the United States Preventive Services Task Force, which examines screening tests and programs and develops recommendations. Clearly defined goals, a central organization responsible for inviting eligible individuals, documentation and quality assurance and balanced information of the public are important attributes of successful screening programs. In Switzerland the establishment of such programs is hampered by the highly fragmented, Federal health system which allows patients to access specialists directly.

The Social Imaginary of Culture/Civilization in the Arabic Literary Tradition

Charles Taylor’s contribution to social imaginaries offers an interpretive framework for better understanding modernity as secularity. One of its main aspects is conceiving of human society in linear, homogenous time (secular time). Looking into the Arabic intellectual tradition, I will argue in my paper that Taylor’s framework can help us understand major social and intellectual transformations. The Ottoman and Arabic modernization process during the 19th century has often been understood by focusing on certain core concepts. One of these is tamaddun, usually translated as “civilization.” I will be mostly talking about the works of two “pioneers” of Arab modernity (which is traditionally referred to as an-nahḍa, the so-called Arab Renaissance): the Syrian Fransīs Marrāsh and the Egyptian Rifāʿa aṭ-Ṭahṭāwī. First I will focus on Marrāsh’s didactic novel “The Forest of Truth” (1865), as it offers a complex view of tamaddun, which has sometimes been construed as merely a social and political reform program. The category of "social imaginary,” however, is useful in grasping the wider semantic scope of this concept, which is reading it as a signifier for human history conceived of in secular time, as Taylor defines it. This conceptualization of human history functioning within the immanent frame can also be observed in the introduction to “The Extraction of Pure Gold in the Description of Paris” (1834), a systematic account of a travel experience in France that was written by the other “pioneer,” aṭ-Ṭahṭāwī. Finally, in translating tamaddun as “the modern social imaginary of civilization/culture,” the talk aims to consider this imaginary as a major factor in the emergence of the “secular age.” Furthermore, it suggests the importance of studying (quasi-) literary texts, such as historiographical, geographical, and self-narratives in the Arabic literary tradition, in order to further elaborate continuities and ruptures in social imaginaries.

Systematic reviews and meta-analyses of randomized trials: principles and pitfalls

Systematic reviews and meta-analyses allow for a more transparent and objective appraisal of the evidence. They may decrease the number of false-negative results and prevent delays in the introduction of effective interventions into clinical practice. However, as for any other tool, their misuse can result in severely misleading results. In this article, we discuss the main steps that should be taken when conducting systematic reviews and meta-analyses, namely the preparation of a review protocol, identification of eligible trials, and data extraction, pooling of treatment effects across trials, investigation of potential reasons for differences in treatment effects across trials, and complete reporting of the review methods and findings. We also discuss common pitfalls that should be avoided, including the use of quality assessment tools to derive summary quality scores, pooling of data across trials as if they belonged to a single large trial, and inappropriate uses of meta-regression that could result in misleading estimates of treatment effects because of regression to the mean or the ecological fallacy. If conducted and reported properly, systematic reviews and meta-analyses will increase our understanding of the strengths and weaknesses of the available evidence, which may eventually facilitate clinical decision making.