Medicine’s Double-Edged Sword
The following is excerpted from MedSmart Patients – the next eBook in the MedSmart series soon to be released.
“Be scared. You can’t help that.
But don’t be afraid.”
Assume you’re handed a medical diagnosis that could be a death sentence. What’s your reaction? If you’re like most people, you’re traumatized, disoriented – maybe even “scared to death”.
This is no state-of-mind to be making life-and-death decisions. Yet this state of shock and fear is a common denominator – to varying degrees – in virtually every serious medical decision we make. Or let others make for us.
Even though we all expect to die some day, the news of how we may die leaves us stunned. This psychological handicap seriously compromises our ability to make informed medical decisions and be full and equal partners in our own healthcare.
Many are rendered impassive in response to a traumatic diagnosis – much like the victims of a serious car crash waiting to be rescued by the EMTs.
And modern medicine capitalizes on this fear to support the inflated incomes of medical specialists and medical centers that perform up to twice as many tests and procedures as are actually needed. Unnecessary tests and procedures inflate our medical bills and raise our risk of treatment-induced injury or disease.
Faulkner’s distinction between being scared and being afraid – the former a temporary state of alarm, the latter a chronic fearful mindset – can help you avoid being victimized by treatment-induced injury and needless medical expenses.
Far too often, we allow fear to drive our acceptance of aggressive medical testing and procedures when the evidence suggests more conservative (less aggressive) interventions or even “watchful waiting” – carefully monitoring our condition before intervening with drugs or procedures that can cause more harm than good – is the more prudent course of action.
Not always, of course, but much more than is currently the norm. We’ve become acclimated by movies and television to “take action” in response to every threat, even when the best course in certain situations is inaction.
Sometimes doing nothing is better than doing something, especially if the something you do may cause you harm.
Popular culture today, however, values impatience and immediacy over caution and sustainability.
Our need for speed is often counterproductive, and nowhere more risky than in our medical care. Sometimes responding quickly to a possible health threat is the best course, but often it causes more problems than it solves.
Since we can’t always determine in advance when it will be helpful or harmful, the default position is to intervene quickly and aggressively.
Such a one-size-fits-all approach to medical needs that are widely divergent will obviously be wrong for many medical conditions, but it remains the default choice because we underestimate the real risks of medical interventions and glorify their benefits.
Trying to impose a black-or-white mindset on high-risk medical needs that are mostly composed of grays can lead to dangerous miscalculations and undesirable outcomes that could be avoided with a more thoughtful and nuanced approach to our medical needs.
The public firestorm following the revision in mammography screening guidelines issued by the U.S. Preventive Services Task Force (USPSTF) in late 2009 is a classic example.
After reviewing the clinical evidence, this scientific panel of medical experts made perfectly sound suggestions that greater caution be used in assuming the risks of annual mammograms for women over 50 and avoided altogether for women under 50.
The media frenzy and public backlash to these findings reveal how we oversimplify medical decision-making by refusing to recognize the downside risks of cancer screenings we’ve been conditioned to accept with unquestioning enthusiasm.
Media coverage of the public backlash against these guidelines suggested the only downsides to mammography screening were many “false positives” (incorrect findings of cancer) and the acute anxiety they provoke.
A report at the annual Radiological Society of North America that roughly coincided with the release of the new guidelines, however, reinforced the need for greater caution.
It found repeat mammograms in young high-risk women carrying a genetic mutation for breast cancer cause more breast cancers than they prevent. The report’s conclusion:
“Low-dose radiation (from mammograms) increases breast cancer risk among young women with a familial or genetic predisposition…mammographic screening doubles breast cancer risk among high-risk women (emphasis added).”
This suggests the real downside risk with mass mammogram screenings isn’t just excess false positives and unnecessary biopsies and the acute stress they cause – for some, it’s more breast cancer itself.
Radiation risk is discussed in detail in Chapter 11, but the bottom-line message is that radiation risk from diagnostic imaging is poorly appreciated by doctors and patients alike, and patient safety measures are inconsistently practiced with lax supervision.
Even the Medical Director of the American Cancer Society responded to the mammogram furor by admitting:
“In the case of some screening for some cancers, modern medicine has overpromised. Some of our successes are not as significant as first thought…
“Cancer is a complicated disease, and too often we have tried to simplify it and simplify messages about it, to the point that we do harm to those we want to help.”
The fact is that most medical decisions are not simple, yet our cultural drive for simple answers and false security causes us to oversimplify our medical choices for ourselves and our families.
These naïve expectations are fanned by overzealous promoters of screening programs that have morphed into a highly lucrative screening industry generating billions in treatment revenues for their affiliated doctors and hospitals.
The media further fuel these unrealistic expectations by “dumbing down” medical news coverage with “gee-whiz” stories often bought and paid for by suppliers of the drug, test, or procedure about which they’re “reporting”.
Media outlets – dependent on advertising revenues for their very survival – are as guilty of financial conflicts of interest as the medical profession they cover (see Our Healthcare Sucks, a MedSmart companion volume).
Chemotherapy is another example of unfulfilled expectations: it doesn’t work very well, in general. On average, 3 out of 4 cancer patients will endure chemotherapy’s well-known “side-effects” – actually treatment-induced disease – for no benefit and substantial harm, but most agree to it anyway.
They’re told that, as bad as it is, it’s their best chance of “beating” their cancer, so they agree to be good soldiers and give it a try. Even when told their chances may be no better than a more conservative approach, many still choose the most extreme approach to treatment out of fear and denial (see breast cancer example below).
Other times, many of us let fear prevent us from acting, most notably during medical emergencies when delay can cost vital heart muscle and/or brain tissue.
Heart attack and cardiac arrest survival rates and stroke disability rates remain abysmally poor due to failure to act quickly when symptoms first appear (see Chapters 4 – 6).
Fear is a common denominator in failing to use the medical system when we truly need it and in allowing ourselves to be victims of aggressive medical treatments we don’t need.
The following video adds further perspective to the toll this misplaced trust in our healthcare system places on families across America.
 Mammography Screening and Radiation-induced Breast Cancer among Women with a Familial or Genetic Predisposition: A Metaanalysis. Radiological Society of North America. Breast Integrated Science and Practice (ISP) Session. 11/30/09.
 New approaches needed for breast and prostate cancer screening: Cancer rates are higher, more patients are being treated and aggressive disease has not decreased. HemOnc Today. 11/25/09.
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