How can medical guidelines be immune from politics?

The recent uproar over the new screening mammography recommendations got me thinking about a lot of stuff. One of the lessons cited by some journalists and pundits is on how potentially volatile information should be presented to the public. The USPSTF was excoriated by critics not only for what it said, but how it said it. While the objections over the former can be dismissed as ravings of loud and poorly informed voices deliberately trying to hijack public opinion, the latter criticism is more insidious.

Some intelligent and balanced observers noted that the USPSTF really should have foreseen the fallout and laid the groundwork to make the sting of the recommendation less pronounced. In the corporate world this is called “making the rounds”. This means that, when you have an idea, it is not enough just to present it on its merits in a group forum. Indeed, you must go around to those whose opinions matter and get them to sign on to your idea before you make it public. In this way, by furthering your relationships, you manipulate the outcome in your favor. This can take countless hours, but this is how things generally get done in the world of business.

The world of politics is similar, in that many reforms and decisions are dependent on behind-the-scenes deal-making between politicians. These clandestine transactions, the theory goes, assure the appearance of a successful outcome in the light of day. And a victory necessarily begets other victories.

Well, to be sure, science and academia are not immune from such politicking and manipulation. In fact, I have heard some assert that our academic institutions are the most politically charged enterprises, even more so than business and politics. So, in that respect, it is not unreasonable to expect some round-making prior to spilling the mammography beans. But what if we question this premise? What if we insist that science remain the last frontier shielded from political influences? I would argue that this should be our only stance on science, be it climate science or medicine. Science should be judged on its merit only, and not on its political ramifications.

In a society where business and political message machines spend countless dollars on market research surveys to package their manipulations to get us to follow their political and consumerist directions, the public is now angry that the USPSTF, a scientific body, did not take the time to effect an elaborate manipulation scheme to get the loud dissenters, and the rest of us, on board with their recommendations. Is it not outrageous that we, American adults, expect, and even demand, such manipulation instead of the straight unadulterated truth?

This is a sad reality of our time, following decades of indoctrination by marketers, educators and other “experts”, to become compliant little consumers that we are today. How easily we are stirred into a rage by callous reporting and special interest demagoguery is telling. We are a mirror-mirror-on-the-wall society: we will not tolerate any truth that does not fit our conveniently preconceived notions of specialness and entitlement. And while this attitude gives us a peaceful soporific feeling one gets following a psychotic rage, it will make it that much more painful when this consumerist fog is replaced by the reality of shortages, as our cheap energy supply dwindles. Unfortunately, by then, it will be too late for the truth to set us free.

There is still time, though! Turn off the television, stop listening to and reading mass-produced messages designed to make you a quiet lemming on its way off the cliff. Focus closer to home, build your local community. And, yes, talk to your doctor about your mammography concerns — you will surely walk away with a more satisfying conclusion and a feeling of self-determination.

Marya Zilberberg is founder and CEO of EviMed Research Group and blogs at Healthcare, etc.

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  • Dan

    See Connecticut Attorney General’s response to the Infectious Disease Society of America’s Lyme Disease Guideline for a prime example of the politicization of science.

  • jenga

    If these recommendations came in conjunction with safeharbor, you would have seen a dramatic difference. With the adversarial relationship this administration has had with the medical community did we expect anything different? Physicians are not going to carry the water for them in the current climate. Let this be a warning.

  • Doc99

    New Mammogram Guidelines – Again

    … D’Orsi and his colleagues reviewed the results of several randomized trials in Europe and North America, which included nearly 500,000 women in total. The review of these studies showed a 26 percent reduction in breast cancer mortality.

    “This is scientifically driven with data, unlike what the task force did,” D’Orsi said.

  • David Allen, MD

    Medical guidelines can never be immune from politics. It helps, though, if you separate politics (i.e., the government) from medicine in the first place. Combining them (Medicare, Medicaid, new health care bill) pretty much ensures they will be entangled.

  • BobBapaso

    Medical guidelines can never be immune from politics. What we need instead are standards of practice formulated and voted on by all practitioners and researchers, each in his own field, through a wikipedia-like web service. Then when a patient considered paying for a service from his health care savings account (or just taking the risk if was covered by insurance) he would know the percentage of informed people who approved of it (or disapproved) and could reasonably decide for himself.

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