Responding to Abigail Zuger’s column in the New York Times. Zuger notes that today doctors spend most time prescribing for pre-illness, which means they try to predict the future.

I am amused by, “For people who feel fine… It is the patient … firmly planted in the here and now, while medical personnel spin wild tales of coming catastrophe…”

and

“In fact, our future of treating pre-illness will simply catapult us right back to a priestly past, as we offer up misty visions of the future and encourage the masses to see with us and act accordingly.”

Zuger’s image – emotional doctors versus patients demanding evidence – captures my experience perfectly. When I declined a mammogram, citing research in top journals, the doctor responded emotionally, literally throwing up her hands: “It must be better than nothing.”

Urging a bone density scan, she cited relative risk (50%) rather than absolute risk (3%). Outpatient surgical clinics require pre-op tests for despite published research consistently showing no difference in outcomes. Most doctors don’t know the Society for General Internal Medicine’s guidelines limit testing for asymptomatic adults.

Doctors eagerly embrace studies questioning the value of herbal or alternative options, but shrug off equally credible reports showing the low value of mainstream “preventive” medicine. In fact “preventive” really means “risk reduction” and often the reduction is so low as to be meaningless. Thus the line between science and magic become blurred, educated skeptics resist medical advice, and most doctors hate patients who know how to read statistics in the medical journals.