Tuesday, December 1, 2009

USPSTF recommendations: Demanding manipulation from science

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.

1 comment:

  1. Wow. Thank you for a refreshing dose of reality. I have noticed and decried the process of "making the rounds" that has come to be expected in "closing the deal" in any case where persuasion is necessary.

    In medicine I've called it the journal club conundrum. When I was in medical school (in the days before Powerpoint) when there was a journal club discussion of a research article with opposing viewpoints, the person who won the debate (so to speak) was the person with the best command of the facts and the evidence.

    By the time I was a fellow (the dawning of the age of the Powerpoint), such disputed articles were normally "won" by the person with the most pizzaz in their audiovisual presentation. The person who could both work the audience and wow the audience. In retrospect, of course, it seems silly.

    Unfortunately, I'm afraid that I have (on this issue) also floated back to the non-scientific appeal to style over substance. I have written elsewhere that the principle problem with the USPSTF was the *way* in which they publicized their recommendations.

    You are correct when you state that science should be judged on its merit, only, not it's political ramafications.

    Thanks again.