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Faith in the protective power of mammography needs to change

7:19 am by | 2 Comments

If you read one article that explains where we are going in Medicine, read this one.

Few procedures have been more entrenched in the dogma of Medical practice than mammograms. In our climate of political correctness and right-think, it would define heretical to suggest a procedure that detects breast cancer–an important killer of women–at an earlier stage doesn’t change outcomes.

Until now.

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But here is the message:

What was isn’t always what is. Things change. Knowledge and evidence should always trump right-think.

It seems to me that the more sure medical people are about something, the more likely it is to be proven wrong.

There was…

  • Low-fat food to prevent obesity and heart disease.
  • Hormone-replacement therapy for post-menopausal women.
  • Widespread PSA screening for prostate cancer.
  • Screening stress tests for heart disease.
  • Non-statin cholesterol lowing medicines.
  • Placing coronary stents and thinking doing so reduces the risk of heart attack.

And soon to fall from medical right think…(My predictions)

  • Internal Cardiac Defibrillators for those with just low-ejection fraction. Look for better predictors of those who will benefit from the invasive and burdensome strategy of implanting an ICD.
  • Giving 80+ year-old patients more than four medicines.
  • Titration of medicine to achieve ideal cholesterol levels.

Good medical practice has one enemy–a never event of all never events.

Hubris.

JMM

Related posts:

  1. How much Medicine is enough?
  2. Concierge medicine makes everyday a snow day. Implications for impending health care reform…
  3. Work-life balance in Medicine–Maybe the young are on to something?

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John Mandrola, MD

By John Mandrola, MD

Dr. Mandrola's post originally appeared on his website. Dr. Mandrola is a cardiologist who specializes in heart rhythm disorders. He writes about doctoring and cycling at www.drjohnm.org and is a regular columnist at theHeart.org.
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2 comments
drjohnm
drjohnm

Thanks for the comment LisaSams. I agree. Doctors have a responsibility to see the truth in the evidence--not just the "expert" consensus. To me, this is one of the greatest strengths of social media and the internet revolution. Namely, that committed folks, regular docs for instance, get a voice. 

LisaSams
LisaSams

Thank you for the clear message that we must all learn to live with imperfect information....uncertainty. Evidence is dynamic growth of knowledge and this is very uncomfortable for both clinicians and patients. I believe we have a responsibility to help our communities understand the value of seeking good information then viewing it in light of their own life...the N of 1 concept. The Cochrane Consumer network is a good resource for plain language summaries.