Editor's Opinion: When Science Meets Sacred Cows
Until a few months ago, the work of the US Preventive Task Force — first convened by the US Public Health Service in 1984 — and the wide variety of their published guidelines had gone mostly unnoticed by the public. Then, the task force’s 2009 update of the 2002 mammography guideline recommended that starting biennial screening mammograms before age 50 should not be routine but instead based on individual factors.1 As soon as the report was released, evidence and science met formidable foes: culture and politics. The former includes a love of technology, years of campaigning to promote annual screenings, and the belief that “if a little is good, more must be better.” Factor in the current climate of political divisiveness, limited scientific knowledge, and a love of sound bites (and electronic networks ready to disseminate them) and a firestorm was ignited. Some politicians jumped at the chance to suggest that the report’s inherent purpose was proof of the desire to ration care; the public responded by protesting in front of their representatives’ offices demanding they “keep their hands off my mammogram”.
Once the battle lines were drawn, the rationale and merits of the actual recommendations were lost, distorted by smoke and mirrors. Similarly, this winter many healthcare providers found themselves in the crosshairs of patients they tried to dissuade from taking a popular antiviral drug to treat their flu symptoms. The message that the risks of developing resistant strains of the virus and drug-related complications may outweigh feeling better an average of 1.3 days earlier2 is difficult to convey when the drug’s benefits are touted in the media 24 hours a day.
Every culture has its sacred cows. Just ask our readers. Armed with scientific data, many clinicians are looking to change entrenched practices and discourage use of favorite toys. Never mind, for example, there is not a shred of evidence to support use of moist or impregnated gauze in order to provide a moist environment3 — we believe it does and it works for us. Comprehending the intricacies of science is difficult enough … communicating them to laypersons or anyone without expertise is a tremendous challenge.
The mammogram clash provides an important reminder to all of us that understanding the data may not be enough to deal with sacred cows. As the amount of evidence upon which we must base our practice increases, so, too, must our ability to digest and interpret it, particularly when that evidence is generated within a politically or commercially flammable environment. If not, the sacred cows will continue to roam.
This article was not subject to the Ostomy Wound Management peer-review process.