I really do not understand all the controversy about the new USPSTF recommendation on breast screening. Actually, I do. I just read an article by Gerd Gigerenzer of the Harding Center for Risk Literacy and colleagues who document the statistical illiteracy of patients and doctors. People in around the world (not just Americans) do not seem to have knowledge of basic statistics and math. We do not understand risk, and what the purpose of screening for disease is. It starts very young, as we do not teach our children the basics of statistics in school.
This combines with a medical-industrial complex that makes us believe that everything modern medicine has to offer is good. Doctors are as guilty as anyone else. We have all come to believe that tests, medicine, and procedures are good. The problem is that modern medicine rests on science, something the previous witchdoctors did not do. If we are going to continue to practice modern medicine, that is based on the science of medicine, then we have to start accepting that all tests and medicines are not always good.
Combine this with the fact that our medical costs are skyrocketing to a level we cannot afford. Indeed the problem with the current health care reform (which I support) is that no one wants to ration care. But, we already ration care. Rationing is not a bad thing: it protects us from unneeded, expensive, and possibly harmful tests and treatments. We have to start realizing that we cannot expect to get every test under the sun whenever we want it. It costs too much, and it probably causes more harm than good.
Let’s all start to educate ourselves on the basics of risk and modern medicine:
- The biggest risk factor for death is being born.
- There are treatments and tests that can harm us.
- Let’s start talking about effective care that acknowledges the limits to medicine.