From what I can see, every medical blogger worth his salt has weighed in on the controversy involving the USPSTF and their new mammography guidelines. I have had a number of respectful disagreements with bloggers that I admire. Although we agree to disagree about the specific guidelines, I would like to use this blog post to detail another important aspect of the current controversy.

By now, we are all aware of the controversy which erupted when the USPSTF came out with new recommendations regarding mammography screening. The recommendations and the subsequent firestorm of criticism have been covered extensively in the media.

The panel (in my opinion) did a fantastic job in compiling and analyzing the very best research and evidence regarding mammography. This research has developed slowly and consistently in the academic literature. Anyone who is familiar with the statistics and recent scholarship in this area would not be surprised that there are ample questions regarding the utility of routine mammograms for women in their 40s without other risk factors.

The USPSTF concluded (similar to many other researchers) that the benefits of screening younger women have been overestimated and that the risks have been underestimated.

Writing in the Boston Globe, op-ed, Ellen Goodman said it best…

“They went on to recommend that women start having mammograms at 50 and then have them every other year instead of annually. But then they dropped these guidelines onto an unprepared public like leaflets from a helicopter of experts who didn’t understand the conditions on the ground.”

Indeed, those of us who think the recommendations from the USPSTF are evidence based, and reasonable have been fighting a battle which has been made harder by at least three factors:

• The main stream media looking for a “controversy” in the story that would capture ratings
• The knee-jerk response that this represents some type of health care rationing scheme by the Obama recommendation and that the administration wants “women to die”
• Legitimate fears of health care consumers which were exacerbated by the two aforementioned factors and the poor public relations utilized by the USPSTF in conveying this information.

In what may be described as the understatement of the decade, Dr. Diane Petetti stated that “We probably, in retrospect, could have been more clear.’’

Carnegie Mellon’s Baruch Fischhoff, an expert in risk communication describes the faults of the USPSTF as one of an external view in conflict with an internal view. He states that what the task force did was to “give an external view of what’s true at the population level.’’ In other words, they told the statistical story from up high, when what the general population was looking for was an internal view; “ does this mean for my life?”

A familiar case of gown being out of touch with town. With striking ramafications.

Gary Schwitzer of the Schwitzer health news blog has done a phenomenal job in documenting the deficiencies in mass media medical reporting. His observations are similar to what many of us who practice clinical or academic medcine would agree with.

I would strongly recommend that my readers refer to his blog for more information on this topic.

The poor communication by the USPSTF cannot be ignored by those of us who are concerned with propagating evidence based guidelines to improve patient care. If we are to move toward practices based on evidence and not anecdotes need to be prepared for the fact that the immediate response by some who have a vested interest in the status quo will be ridicule, questioning of motives and false allegations. Taken from this perspective, the controversy and vilification of the USPSTF represent a head-on assault at evidence based medicine.

The traditional medical scholarly publishing model is clearly in the process of being disrupted by more direct online communication. We are moving quickly into an age where the adoption of digital record-keeping along with accelerating quantities of outcomes based data from registries and EHRs will enable new models for medical research and analytics. If those of us who value evidence based medicine are content to have our side of the story conveyed on the editorial page of the NEJM we face the real possibility of being scooped and outflanked by bloggers and the twitterverse.

As recently commented on by Janice McCallum “Interpreting the results from the increasing number of empirical studies will take skill in statistics, public health and communication.” Perhaps it is unreasonable to think that public health scientists shoud also become public relations specialists, but the recent brouhaha over the USPSTF recommendations make it clear that this is a skill that will be in much demand.

We desperately need a new model for medical information communication that can translate and publish the most recent medical data into a form that can be easily digested by the general public.

We desperately need a new model for medical information communication that can translate and publish the most recent medical data into a form that can be easily digested by the general public.

This episode has highlighted the fact that the facts don’t speak for themselves. They need to be delivered by people who have not only facts, but context and who can frame the message as a story to a prepared public. Only then will the evidence become relevant and suitable for general dissemination.