One of the mantras of traditional reformers is that smaller classes for students are optimal. Indeed, local school boards and teachers’ unions often warn of expanding or exploding class sizes if requested levies are not passed. They know that we parents believe that class size varies inversely with the quality of education. Ask parents if they would prefer a class of 20 or a class of 30 students for their youngsters and all will opt for the former.
Are smaller classes really better, or do we just believe they are because our intuition instructs us that it is? Is something true because it seems self-evident to us?
I found recent New York Times article on this issue very enlightening. There are education experts who are not convinced that larger classes compromise educational quality. Are they right? I can’t say, but I’m happy to see that not everyone is drinking the Kool Aide. Assumptions are not data.
The medical profession is permeated by myths that we physicians and the public believe to be true, but may not be, or have not been rigorously tested. Practices and procedures that are done routinely and repeatedly are considered to be standard medical practice. In other words, evidence is not needed.
Consider the following medical procedures and offer a view if they are sound practices or medical myths.
- Lowering your cholesterol level will have a significant impact on your risk of developing heart disease or stroke.
- Influenza vaccine is a highly effective vaccine and should be administered yearly to all eligible individuals.
- It is important for physicians to check patients’ reflexes during physical examinations to determine if subtle neurologic injury is present.
- Vitamin supplements are important to maintain good health.
- Early detection of disease leads to better outcomes.
- Probiotics cure everything and should be mandated for all school children.
- Periodic laxative use is advised to cleanse the colon of injurious toxins.
- Adults should have their abdomens examined at least every 3 years to discover if any tumors or organ enlargement have occurred.
- Yearly eye examinations are necessary to screen for glaucoma and other eye disorders.
- Colonoscopies have been proven to prevent colon cancer.
- The prostate-specific antigen (PSA) test saves lives and should be measured periodically in men starting at age 50.
- If a cardiac catheterization shows a narrowed artery, then a stent should be inserted to prevent a heart attack from developing.
- Pelvic examinations in women are important opportunities to detect ovarian cancer at an early stage.
- Mammography is proven to save lives.
- Fiber supplements benefit patients with irritable bowel syndrome.
- Patients with acute back pain benefit from an early MRI to guide medical treatment.
- Medical bloggers always tell the truth.
Was it Frederick II who wrote, "Nuance, toujours nuance"?
ReplyDelete@AB, very erudite. I had to google your foreign phrase. Good to hear from you again. Missed you last week. MK
ReplyDeleteMyth, myth, myth, myth, myth...yup all myths. Think of the money that would be saved if people would just forgo your list.
ReplyDeleteThat said...I wish my kid were in a smaller class.
It truly is incredible...then when you consider some of the "less" established procedures and how they become the standard of care...the costs are staggering.
ReplyDeletePSA screening definitely prevents deaths from prostate cancer - witness the 40% decline in U.S. age-adjusted prostate CA mortality since the introduction of PSA testing in 1990, as well as results from the European Randomized Screening for Prostate Cancer study. Problem is, the median age of death from prostate cancer is 80. So, many of the men who don't die of prostate cancer because of PSA testing probably end up dying of something else at the same age, and overall mortality may not be affected. The argument could be made that almost anything is better than dying from prostate cancer.
ReplyDeleteTake-home message for me is that PSA screening has to be applied more judiciously: start earlier (40), stop sooner (70), and screen lower-risk men less often (every 3-5 years). One of the public health tragedies of the past 20 years is that more men in their 80's are being screened with PSA testing than are men in their 50's.
Thanks, Mark, for your comment. I suspect that more men have been harmed by PSA testing than have been saved by it. Most of these men would have lived out their natural lives with silent prostate Ca, that would have never made them ill. The complications and expense of overtreating are self-evident. To my knowledge, we do not have a reliable method to target those men who are destined for severe disease, assuming that intervening would change the natural history here.
ReplyDeleteI am an associate professor of Internal Medicine and have been teaching in the same medical school and working in the same county hosptial for 25 years. I have taught about the myths you listed. One theme I have had over the years is that medical schools do not teach medicine. Rather, they indoctrinate students and residents into the medical industrial complex. They systemiatically teach what is false becasue what is false brings money to them and to those who support them. I had a letter published in the NY Times on April 17. In that letter I said that academic medicine is backward and corrupt. Until academic medicine is reformed, and perhaps until academics in general is reformed, we will continue to go in circles with our myths.
ReplyDeleteW. Robert Graham, M.D.
Thanks, Robert for your point of view that it is a 'myth' that academic medicine is pure. I sincerely hope you will follow this blog and contribute.
ReplyDeleteThe AMA is by far the biggest PAC on the block. I can't take your complaining seriously.
ReplyDelete@anonymous, you have no quarrel with me. Search 'AMA' on this blog and you'll see we have similar views on this organization.
ReplyDeletecomments on practices or myths:
ReplyDeleteyes;disagree;no; depends on who you are and what you eat; prevention is better than the cure; too many variables; not important; not important if you look after yourself but only very few do;not important; n/a, n/a; depends on the type of examination; mammography can cause cancer; learning to eat and shit correctly is the course of action but few will ever achieve; the person has to take control and manage their back; yeh right -NO!