Fear and outrage about science

December 6, 2009

Feels like old news by now, but the recent dust-up in relation to new breast cancer screening recommendations put forth by the U.S. Preventative Services Task Force deserves a post. Oh so much uninformed outrage – some of it genuine – some of it expressly for political gain: mostly all of it disregarding some very simple facts. Instead of really authoring a post, I’ll include below a response to a local talk show host (whom I admire a great deal, by the way) who weighed in on this topic:

Let’s dig a little deeper, shall we

First off, I’m not convinced that this new set of recommendations in any way could be considered a substantive ‘cost saving’ measure. These primary prevention tests are an infinitesimal portion of the overall healthcare dollar. I don’t think there’s enough crack on the planet which, if smoked, would lead one to conclude this recommendation would bend anybody’s ‘cost curve.’

To the issue of some ‘impersonal commission’ who, pray tell, *should* make these guidelines? The patients themselves? Each individual physician? Surprisingly (at least to me) your reaction to this is very anti-science. Who better to make recommendations than professionals who have actually looked at the data and have made a professional determination based on that data. What’s your alternative?

You seem to forget how women came to expect the annual mammogram at 40 and routine self-exams as the way to go. It was likely this same body (or one very similar). So you’re put in a position now of essentially saying "don’t bother me with any new facts – just keep telling me the same thing you told me 20 years ago."

What this recommendation highlights (and, very coincidentally, the recommendation from the ACOG {American Congress of Obstetricians and Gynecologists} regarding cervical cancer screening) is that we *do* need to be continually evaluating care guidelines and adjust them based on the actual clinical outcomes. The reaction to this update (and the accompanying political whiplash) is another reminder of how out of whack our sensibilities are about the delivery of health care. We seem to operate under the assumption that more care is always better. The facts are that the data show that this is not universally the case (see the Dartmouth Atlas of Health Care for clues). Uninformed (bordering on petulant) reactions don’t help us here. Let’s at least try to think things through whenever possible.

As I re-read the thing, I don’t see a whole lot more I’d add to the post (without making it completely unwieldy by diving into the changes in recommendations point-by-point).

And … yes, I know I do not have a cervix. If you think that disqualifies me from opining on this topic, you are free to make that judgment. Know that it’s not likely to keep me quiet.


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