American Medicine Can't Decide If We're Testing Too Much or Too Little

A PDF of 14 pages, and no answers

Fred Pelzman, a primary care physician who writes for MedPage Today, described getting a portal message from a patient carrying 14 pages of lab results. Attached was a note: "Speak to your PCP about these results and next steps you may want to take."

The patient had gotten the tests done at a stand-up lab or wellness clinic, not from Pelzman. Nobody there explained what the numbers meant. Nobody there is treating that patient long-term. Pelzman says he often doesn't even recognize half the tests and has to look them up.

His point isn't that testing is bad. It's that testing without a doctor attached to the result and a plan for what to do with it is mostly theater. "Don't order a test that you don't want to know the result of," a mentor once told him in medical school, "or you don't know what to do with the result of it when you get it." Order enough tests on anyone, he adds, and something will come back abnormal. That's statistics.

The Pentagon goes the other direction

While primary care doctors are drowning in unsolicited labs, the Pentagon is adding a mandatory one. Defense Secretary Pete Hegseth's memo requires testosterone screening for service members, according to the Epoch Times, though the operational details, what happens with a low result, whether it applies to women, whether treatment will actually be voluntary, are left to guidance that hasn't been written yet.

Dr. Mohit Khera, a urologist at Baylor College of Medicine, told the Epoch Times about a service member who avoided getting his testosterone checked at all out of fear a low result would trigger a waiver process or complicate deployment. Instead the man used testosterone without any medical monitoring. "We just take the testosterone. This way we feel better. We don't have to worry about it," Khera recalled him saying. Khera called that dangerous. A mandatory test that carries career consequences can push people toward doing the thing unsupervised instead of reporting it.

Adm. Brian Christine, a urologist who worked with Hegseth's team and now serves as assistant secretary for health at HHS, told the Epoch Times that testosterone screening for men starting at 30 has long been advocated by men's health specialists generally, not just for the military. Dr. A. Michael Lincoff, the Cleveland Clinic cardiologist who co-led the TRAVERSE testosterone safety trial, pushed back on how common true symptomatic low testosterone actually is in a young, fit population, noting body fat is the strongest correlate of low levels. Whether the Pentagon's new mandate solves a real readiness problem or creates a new bureaucratic one remains an open question, because the guidance governing consequences hasn't been published.

The screening test that turned out to matter

Not every test is noise. Joseph Wayne Singleton, a 45-year-old musician from Opelousas, Louisiana, told Fox News Digital he went in at 33 mainly to prove his wife wrong that he needed a more thorough physical. His doctor, without a clear reason he could articulate, ran a PSA test even though Singleton was well under the age current guidelines recommend for prostate screening. The result came back, in Singleton's words, "through the roof." He was diagnosed with prostate cancer at an age his doctors at UT MD Anderson said they'd rarely seen it. He had zero symptoms.

Robert Smith of the American Cancer Society told Fox News Digital that screening protocols differ by patient and current guidelines don't recommend routine PSA testing in men Singleton's age. Singleton's story is real and his outcome is good. It's also an outlier, not a case for scrapping age-based guidelines, and Smith's caution matters just as much as Singleton's advocacy.

The mammogram number that just got smaller

A study published Sept. 14 in the Journal of the National Cancer Institute, led by Sisse Helle Njor of the University of Southern Denmark, found breast cancer overdiagnosis from screening—detecting a tumor that never would have harmed the patient—occurs in fewer than 5% of screenings. That's a sharp drop from earlier estimates of 30% to 50%. Njor's team says those older estimates were flawed because they only tracked patients for a limited window after screening began. Researcher Elsebeth Lynge said the earlier studies didn't account for the fact that cancer diagnosis rates naturally spike right after screening starts, then should fall later, a pattern that gets distorted if women keep getting screened after a trial officially ends.

This undercuts a decades-old argument against routine mammography, that it mostly finds cancers that would never have mattered. The concern that overdiagnosis leads to unnecessary surgery and chemotherapy is a legitimate one that shaped screening debates for years. This study, based on eight randomized trials plus long-run Danish data, is evidence that the scale of that problem was overstated, not evidence it didn't exist at all.

The SSRI fight nobody's finishing

HHS Secretary Robert F. Kennedy Jr. has pushed for tighter diagnostic criteria and wider adoption of deprescribing programs for antidepressants, according to Psychology Today. Roughly 1 in 6 Americans are on an SSRI, and about 70% of them have been for two years or longer.

A New York Times panel featuring psychiatrist Anthony Rostain, physician Rachael Bedard, and columnist David Wallace-Wells wrestled openly with the fact that antidepressants are still prescribed widely even though the original theory of depression they were built on has been abandoned. Rostain called that an uncomfortable but healthy question to be asking.

Men's Health contributor Dr. Gregory Scott Brown pushed back with a piece titled "Antidepressants aren't the problem," and Psychiatric News had already labeled the fight "The War on SSRIs" back in June. Psychology Today framed the debate as including "signs of a coordinated pushback to defend them from further scrutiny" in parts of the media. Readers should treat such characterizations as interpretation rather than established fact.

What's undisputed: withdrawal effects, sexual dysfunction, and weight gain are real and acknowledged even by defenders of the drugs. What's unresolved is whether tighter screening before prescribing, the same instinct driving the Pentagon's testosterone mandate and the wellness-clinic backlash, would reduce harm or just leave more people undertreated. No federal rule change has been announced. RFK Jr.'s push remains a policy push, not yet a regulation.