Sleep of Reason Produces Monsters

Emotion Defeats Reason Defeats Evidence

A study of mammography outcomes in the New England Journal of Medicine illustrates how emotion and rationalization can defeat the evidence about medical outcomes. The study created great controversy and media attention because it provided further evidence that mammograms do not affect outcomes (death rates) from breast cancer. Such a bold conclusion challenges established cancer screening practices.

The oddity here is that mammograms are still an accepted medical practice even though controlled clinical trials, published more than ten years ago, provided evidence that women who received mammograms were just as likely to die as women who did not get this screening test.

Why, despite clear evidence from several clinical trials — with approximately 600,000 women randomized to receive either mammogram screening or not to get the test — do doctors keep doing the same things? The results from numerous clinical trials found mammograms increased diagnoses and surgeries, but didn’t save lives. The results sound pretty clear, yet doctors still screen, radiologists diagnose, surgeons cut, and pathologists examine.

When will we be ready to stop ignoring the evidence is a serious question raised by David Newman, author of Hippocrates Shadow and Director of Clinical Research at the Mt. Sinai School of Medicine, in a recent New York Times op-ed. How can it be that such a medical practice continues despite yet another large observational study that underscores previous rigorous evidence that mammograms do not work? Is our medical establishment so attached emotionally to the concept of early detection that it rationalizes practices that the evidence says has no value?

The evidence, says Newman, seems to get lost in wishful thinking and delusion that trumps the science. Prostate cancer is another case where screening that hurts more than helps continues, despite the evidence. Back surgery provides yet another case worth examining. Seeking truth in medical practice will improve outcomes for patients and help to decrease harmful and wasteful healthcare spending.

Click here to read the New York Times editorial on the mammogram studies, and here to read the NEJM study entitled, “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence”.

The Sleep of Reason Produces Monsters, Francisco de Goya, image from Wikimedia Commons