“Between the Lines: Finding the Truth in Medical Literature,” by Marya Zilberberg, MD, MPH….and “The Patient Paradox: Why sexed-up medicine is bad for your health,” by Margaret McCartney, MD, are two books to add your reading list.
I’ve written several times about smart blog posts by Zilberberg, an adjunct professor of epidemiology at U-Mass Amherst. In her book, she urges:
“We need to acknowledge the colossal uncertainties in medicine. Once we have done so, we need to understand that such uncertainties require a probabilistic approach in order to optimize care. Finally, such probabilistic approach has to be taught early and often. All of us, clinicians and patients alike, are responsible for creating this monster that we call healthcare in the 21st century. We will not train it to behave by adding more parts. The only way to train it is to train our brains to be much more critical and to engage in a conversation about probabilities. Without this shift a constructive change in how medicine is done in this country is, well, improbable.”
She addresses the role of journalism and other factors in the dissemination of health care news:
“as news outlets continue to pump out breathless reports of medical breakthroughs that make it look as if immortality were just around the corner, both lay people and those trained in the clinical sciences are put off by the escalating complexity of medical literature and leave truth finding to others. Such abdication is fraught with consequences, since those who are charged with interpretation and decision making are, on the one hand, not always equipped to do it and, on the other, view the task through the prisms of their own values and experiences. And, yes, clinical science is sufficiently imprecise to lend itself to such varied conclusions. How often have you heard the warning “Buyer beware”?
McCartney is a GP in Glasgow, Scotland. We just met two weeks ago at the Selling Sickness conference in Washington, DC. She’s written for UK newspapers, and for a BMJ Medicine and the Media column. I’ve written about her blog posts several times as well. In her book, she writes a great deal about screening tests. For example:
“The reality behind prevention is one of medicine’s dirty little secrets. The cervical screening programme, for example, manages to create a vast number of cervical smears that are borderline’ or abnormal’, causing the need for further testing and enormous anxiety to the women concerned – despite the fact that most changes would revert to normal all by themselves.
First do no harm’
Screening throws Hippocrates out of the window. We have no screening test without side-effects. Harm is inevitable.”
She writes about DCIS or ductal carcinoma in situ, which is being diagnosed more frequently with more mammograms being done more often in younger women. And she writes about disease awareness campaigns.
“It seems that the more sellable a health problem is and the more sexed-up the proposed treatments, the worse we are informed about it. For example, the entire month of October is devoted to breast cancer awareness’. But we know that women underestimate the average age of being diagnosed with breast cancer, overestimate their risk of dying of it, and overestimate their risks of getting it. The young women who often appear on breast cancer awareness’ posters probably don’t help.”
McCartney devotes an entire chapter to “The Problems With PR.” When I met her in Washington, we talked about our joint interest in establishing criteria for health/medical/science news releases. I hope that we will be able to work together on this.
I have far too many notes on these two books to capture in one blog post. Read. Get smarter. Then spread the word.
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