This post is provoked by the recent news on statins (e.g., see “If You’re Going To Die Soon, Do You Really Need Statins?”). I received a bunch of posts on the subject with a much-opened mind because I just finished the book Overdiagnosed. I in turn had received the book’s message with a mind more open than it used to be because of recent events in my family’s health.
Perhaps ironically, it was anecdotal evidence that made me more open to learning how much anecdotal evidence feeds in to the healthcare decisions people and their doctors make and how a lot of these decisions should be called into question (as was the question of whether statins should continue indefinitely). I have relatively recently gone through a major family health crisis (my grandpa) and a death (my dad). With both I learned that my family tends to approach things differently than most of the American public. I hadn’t paid much attention before.
This is notable because both of my grandparents are 94, and although they’re in assisted living since my grandpa’s stroke, they don’t get much assistance. They don’t need it. My grandma takes one prescription medication, and my grandpa takes a few more since since his stroke. They’re healthier than most people I know. They have always questioned medical decisions, and this may be where I get the trait, but from a greater distance I am now very interested in this. The examples they set for me were things like this:
- My grandpa was diagnosed with prostate cancer 15 or 20 years ago. Nobody got worked up. He asked questions instead, like “what will happen if I do nothing?” He decided to do nothing. Back then, the decision seemed crazy to most people.
- My grandma was told she had diabetes, probably around the same time. Again: what would happen if she did nothing? She figured she would not live long enough to see the end-organ damage that comes with diabetes (although we’re beginning to wonder, now). She did begin to eat more healthfully and exercise more, but she has never again checked her blood sugar or taken medication for diabetes.
- My dad initially questioned everything about his cancer. He had worked in public health and knew the tricks epidemiologists use (your chance of cure may “double” with a drug that has horrific side effects, but if that means your chances go from 1 in 10,000 to 2 in 10,000, no thanks).
- After my grandpa’s stroke, the family questioned every drug he was given. Was it absolutely necessary? What would happen if he didn’t have it? This would have driven me insane as his nurse, but the man recovered from a fairly scary hemorrhagic stroke.
These scenarios are all addressed in Overdiagnosed. More interestingly, it discusses how politicized our nation’s screening and preventive recommendations are, particularly for breast cancer. Using people’s fear to make money is surely morally wrong.
But this isn’t a book review; it is intended to spur nurses to think about what we pay lip service to. When patients ask us whether they should have a test or why the doctor ordered it, do we mindlessly say what everyone “knows,” or have we taken the time to educate ourselves before we try to educate patients?
It’s a bit of a problem because it takes time and effort to track down what statistics actually mean. I would recommend that nurses do take the time to inform themselves with the screening and preventive procedures relevant to their specialty: are we giving good education?