When Good Medicine Goes Bad

"I think that the U.S. Preventive Services Task Force learned there is a certain science to communication just as there is a science to treatment," said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

He said that while the guidelines were not that different from those of the American Cancer Society, the way they were communicated caused an outcry, in part because it led some to believe a lifesaving tool was being taken from them.

The problem, Brawley said, came from both sides. Physicians in favor of screening "seem to be complacent with the technologies we have now," without acknowledging the false positives they pick up, he said.

At the same time, he said defenders of the USPSTF's recommendations seemed to ignore the fact that some clinical trials indicated lifesaving benefits from breast cancer screening (a benefit not yet known in, for example, prostate cancer screening).

Grady acknowledged that a challenge for doctors will be communicating the need to cut back on treatments.

For many scans, she said, we don't know that they find cancers that will actually affect a person.

A common example, Grady said, is a patient who comes into the emergency room with a cold and where a (needless) chest x-ray appears to show a growth in the lung.

If there is no cancer, the patient is relieved, but if doctors had followed best practice, they wouldn't have gotten the x-ray.

"We know that doing a chest x-ray just for the hell of it not only isn't effective, but it identifies people with lung cancer that was never going to bother them," Grady said.

But as doctors are called upon to communicate better, patients may need to heed a similar message.

Hadler said spotlighting overused treatments and procedures will benefit involved patients.

"One can start to ask 'how certain are you that a particular intervention will actually benefit me?'" he said. "The patient has to demand information. They need to take responsibility for medical decision-making for them."

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