But
while I am deeply committed to scientific research,
I find myself less enthusiastic about the lack of clarity
new findings bring to old truths. It is confusing.
I am not an expert. I have more important things to
do than track down and evaluate new findings that overturn
previous assumptions about what I can do to stay healthy.
For
example, take something basic like cancer screening
for breast cancer.
In
the old days, when early detection technology was so
primitive it could only identify large tumors, there
was little ambiguity about the finding of cancer. Today,
however, screening technology allows for the identification
of a few abnormal cells that may meet the pathologic
criteria for cancer but would never bother patients
if they were left alone.
Breast
cancer isn’t one disease. Cancer is a spectrum
of diseases. Some of them can be very rapidly fatal
and some not. The trick is to be able to distinguish
between them and to treat them accordingly, and research
is making headway on doing so. But it’s not there
yet.
In
the meantime, just to be safe, most of them are treated.
But a shotgun approach to screening and treatment can
inflict unnecessary surgery, anxiety, radiation, depression,
chemotherapy and fear. In the absence of better evidence,
the best solution is a discussion about one’s
personal risks and preferences with a trusted care
provider – informed consent delivered well.
It
is a sign of progress in medicine that tests and treatments
will be increasingly tailored to an individual’s
own genetic make-up and personal history. Broad, one-size-fits-all
prescriptions are already losing their potency as they
are challenged by new studies casting doubt about the
universal value of low-fat diets, about breast or prostate
cancer screenings and about the use of certain antidepressants.
This
progress comes at a price, however, and the price is
uncertainty. Although human nature demands binary "do
this" or "don't do that" advice, we
now have to hack our way through a thicket of nuance
to find that the definitive answer to the question, “Should
I get this test?” is a qualified, “Maybe;
it depends.”
It
is ironic that as research supplies us with new answers
about the determinants of health and disease, health
care providers are ever less available to help us personalize
the new evidence to guide our decisions. So really,
what is happening? New evidence floats away, not used
by many people because it is too complicated to apply
to their own situation without the help of an expert.
This
paradox will need to be solved if we are to fully capture
the value of health research.
