Kevin Sack's news analysis on this week's turmoil as the U.S. Preventive Services Task Force revised its evidentiary review on the frequency of recommended mammograms surfaced cultural values colliding as "the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright."
Sack continues:
The backers of science-driven medicine, with its dual focus on risks and benefits, have cheered the elevation of data in the setting of standards. But many patients — and organizations of doctors and disease specialists — find themselves unready to accept the counterintuitive notion that more testing can be bad for your health.
“People are being asked to think differently about risk,” said Sheila M. Rothman, a professor of public health at Columbia University. “The public state of mind right now is that they’re frightened that evidence-based medicine is going to be equated with rationing. They don’t see it in a scientific perspective.”
For decades, the medical establishment, the government and the news media have preached the mantra of early detection, spending untold millions of dollars to spread the word. Now, the hypothesis that screening is vital to health and longevity is being turned on its head, with researchers asserting that mammograms and Pap smears can cause more harm than good for women of certain ages.
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The challenge of persuading patients and doctors to accept such standards requires a transformational shift in thinking, particularly when the disease involved is as prevalent, as deadly, and as potentially curable as cancer. How do you convince them that it is in their best interest to play the odds when they have been conditioned for so long to not gamble on health?
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As throughout history, it may take decades for medical culture to catch up to medical science. Dr. Rothman pointed out that it took 20 years for the public to accept the discovery in 1882 that tuberculosis was caused by a bacterium and not by heredity or behavior. More than 160 years after the Hungarian-born physician Ignaz Semmelweis posited that hand-washing could prevent the spread of infectious disease, studies still show that half of all hospital workers do not follow basic hygiene protocols.
Note: the story makes no mention of salt. Whatever the merits of the quality of the science under discussion in this particular issue, this analysis squarely identifies the problem facing public health policymakers -- how to reverse massively-promoted interventions when the evidence no longer supports that intervention? Think of the salt and health controversy, now. The same dynamic applies.
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