Doctor-patient calculus trumps medical statistics

Doctor-patient calculus trumps medical statistics

Sometimes anecdotal evidence trumps science in setting public policy. And that’s not necessarily a bad thing.

A prime example of the conflict that arises between conventional wisdom and empirical data played itself out in headlines last week over recommendations released by a task force on when and how often women should receive mammograms and whether women should be taught to conduct self-exams.

The task force recommended less frequent mammograms starting later in life than the American Cancer Society and some other advocates suggest, setting off a series of reactions, including a claim that the task force’s recommendation was an example of government rationing in the making.

Who are these people?

The task force has no ability to ration care, and if it did, the public reaction to its report is a good example of why any rationing scheme that wasn’t perceived to be in the public interest isn’t about to happen in the United States.

First, as Douglas Kamerow and Steven Woolf, professors of family medicine at Georgetown University and Virginia Commonwealth Univer–sity respectively, pointed out in a Washington Post column, the U.S. Preventive Services Task Force is not made up of government bureaucrats. Its members are doctors, nurses and methodologists from universities, health systems and public health agencies who are experts in assessing preventive services. The task force is a creation of Congress and has been around for 25 years. Its recommendations are not binding on anyone.

Second, if the task force had been in the business of recommending rationing, it would be out of business this week. The vociferous and immediate reaction to the task force’s suggestions would have assured that.

The largest obstacle to the task force’s recommendations being widely accepted inside and outside the government was the power of personal experience — that is the testimony of women who knew personally that early mammograms and self-examination found the first signs of breast cancer and gave them a chance of beating the disease.

No amount of science that suggests American women may be getting too many mammograms or wasting time with self-exams trumps real women telling their stories about lives saved and families kept intact.

At the end of the day, the task force provided data that will give doctors something to talk about — among themselves and with their patients. And that is as it should be.

Testing methods improve

Obviously, mammography is an imperfect tool; so are colonoscopies used to screen for rectal cancer or PSAs that screen for prostate cancer.

And, just as obviously, all those tests have gotten better over the years and will get better in the future, or be replaced by new and better protocols and procedures.

What the task force or the Cancer Society or the American College of Obstetricians and Gynecologists recommend is not nearly as important as the information shared between patient and doctor. They ultimately will make the life-and-death decisions.

Women (and men) who keep themselves informed about their bodies and have regular check-ups increase their chances for catching any disease at an early stage. The earlier the better.

U.S. Preventive Services Task Force has no interest in coming between a doctor and his or her patient — and can’t unless the doctor and patient allow it.