I've been reading and listening to the debate on the new screening guidelines from the U.S. Preventive Services Task Force for almost a week now and trying to sort through the various claims.
Two historical figures who have fascinated me for years have stories that seem pertinent to the debate. The first is Dr. Ignaz Semmelweiss, a Hungarian-born doctor who worked on the maternity ward of a hospital in Vienna in the 1840's. Semmelweiss noticed that the mortality rate from childbed fever was three times higher on one ward than another. In those days people didn't think in terms of public health statistics, but Semmelweiss wanted to figure out the difference in mortality. In one ward, midwives took care of the patients; in the other doctors and medical students were in charge. Unfortunately it was the latter ward that had the higher mortality rate.
What if the doctors, who came to do their rounds straight from the autopsy room, were bringing in some sort of agent that was causing the problem? Semmelweiss tested his hypothesis by washing his hands before he examined patients, and he made the medical students who worked under him do the same. The mortality rate dropped dramatically!
Semmelweiss thought other doctors would want to follow his lead, but his findings flew in the face of established medical theory and practice; and Semmelweiss was essentially laughed out of Vienna for his crazy ideas. He went back to Hungary, where he was able to repeat the mortality reduction for post-partum women, but where he couldn't convince any of his colleagues that he was right.
In the 1850's, Florence Nightingale, working in a military hospital in Turkey during the Crimean War, effected a dramatic drop in mortality by keeping wards clean. Nightingale wondered if a connection existed between proper sewers and sanitation and healthier soldiers. What if the army made sanitation as important as marching? Folks laughed at her too. However, she refused to let the condescension of military men towards a meddling spinster with strange notions silence her. She spent the rest of her life pushing for proper cleanliness and sanitation in volumes of reports filled with charts of statistics and mortality tables. To help the officials understand the statistics, she invented the pie chart that shows percentages.
Which brings us to November 2009. All week long people have been arguing statistics and what they mean in terms of public policy.
The U.S. Preventive Services Task Force (USPSTF), organized in 1984, has a mission, "to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." In other words they crunch numbers to decide what works best.
