Opponents of science-based medicine like to accuse the rest of us of failing to be “holisitc”, of failing to see the whole individual who comes to us for health care. I’ve argued many times that this is not only wrong, but that so-called alternative docs, by recommending unproven treatments and giving false hope are actually harming their patients. The new USPSTF mammogram recommendations are likely to fuel this debate as well as the one regarding health care reform and rationing. There’s already been a great deal of debate new mammogram recommendations, most of it good. For a comprehensive analysis of the topic, go and read Orac’s take.
What much of the debate fails to recognize is that data are amoral. They are a tool. There is no reason to doubt the data the USPSTF has put forth, whether we like it or not. Data is useless unless it guides real decisions, and this is where our ethics as a profession and as a society come in. The new recommendations tell us that we would have to screen about 1900 women in their 40s for ten years to prevent a single breast cancer death. Many of the other women will undergo unnecessary imaging studies and biopsies, none of which are completely benign. A typical gynecology office may have about 1900 women in their 40s so if one office stopped screening women in their 40s, they might have one excess death—and a lot fewer sleepless nights worrying about an abnormal test, a biopsy, a breast MRI.
That’s the data. We are better served knowing it. What we do with will be a reflection of what we as a society value, both morally and economically. Using our values to make informed medical decisions is not anti-scientific, it is human. If we ignore the data, we are practicing medicine without a brain. If we ignore the human element, we are practicing without a heart.