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medpundit |
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Monday, January 20, 2003Preventive medicine displays all 3 elements of arrogance. First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law (immunizations, seat belts), it prescribes and proscribes for both individual patients and the general citizenry of every age and stage. Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them. Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations. He goes on to make a good point, that we aren’t discriminating enough in the preventive treatments we offer people. Of all the preventive measures we take, colon cancer screening and pap smears are probably the only that are truly effective and worth their cost to the individual. The rest - cholesterol drug therapy, mammograms, osteoporosis prevention , prostate cancer screening - aren’t nearly so clear cut when it comes to cost vs. effectiveness. Yet, we continue to urge them, sometimes force them, on people. I received last week my yearly accounting of preventive services from all the managed care companies that cover my patients. They’re full of names I recognize as people who have been offered but declined health screenings such as cholesterol (“Listen doc, I’m not going to do anything about it anyway so there’s no need to test me.”) to mammograms (“Honey, I’m 90 years old. If breast cancer kills me, it will be a blessing.”). The purpose of the lists is to 1) rate my performance in delivering preventive care and 2) hope that I’ll put pressure on the deliquents to improve my rating. Aggressively assertive, presumptuous, and overbearing. I also like the letter from another Canadian physician in support of his position: David L. Sackett's commentary on preventive medicine is a breath of fresh air which should become a hurricane in this world where life is becoming increasingly "medicalized." His last paragraph is particularly apt: "Experts refuse to learn from history until they make it themselves, and the price for their arrogance is paid by the innocent. Preventive medicine is too important to be led by them." One might add a remark from an essay by Lancelot Hogben, a British scientist and economist, born in Portsmouth in 1895: "No society is safe in the hands of its clever people." (via Colby Cosh) posted by Sydney on 1/20/2003 06:50:00 AM 0 comments 0 Comments: |
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