Libresco: Against action-packed arguments

October was Breast Cancer Month, and the events at Yale were similar to those across the country: fundraisers, as well as awareness campaigns built around saucy double (or single) entendres. Unfortunately, there were also anti-scientific editorials. The Yale Herald ran an op-ed by Pooja Verramilli slamming new recommendations by the United States Prevention Services Task Force (USPSTF) for women over 40, which advise them to reduce their mammograms to once every two years and for women under 40 to skip them altogether.

Verramilli made the correct argument that, under the new screening criteria proposed by USPSTF, some women will not be diagnosed with breast cancer until it is too late for effective treatment. Their lives would have been saved under the old system. However, some women who do not have breast cancer or who had small, non-aggressive tumors that did not require invasive treatment will live fuller, healthier lives than they would have had they been screened. The approach proposed by Verramilli only makes sense if our primary goal is to reduce deaths from breast cancer, rather than to promote health and wellbeing.

The Herald gave this wrongheaded view a forum in their Opinion section and lent it credence in their Index feature, which presented a slew of figures promoting mammograms as though they had no downside. Although the stats were mostly comprehensive — including annual deaths, number of women at Yale and average length of a mammogram — they only present one side of the story.

The Herald should have included data on numbers of misdiagnoses expected in 2006 as well as the number of mistaken biopsies, surgeries and courses of chemotherapy that these misdiagnosed women would undergo. The newspaper should also have included days lost from work, medical bills for unnecessary treatment and years of life lost to toxic treatments. It didn’t include those numbers because the editors fell prey to a common flaw in human reasoning: we tend to reckon the cost of inaction as higher than the cost of action.

Americans are terrified of passivity, no matter how costly or destructive action may be. “Better not to take a chance” is the rallying cry of mammogram enthusiasts, the beachgoers fleeing a hypothetical Shark Week and TSA administrators banning water bottles. If bad things are going to happen to us, we want to make sure there’s no preventative measure we didn’t take and no way misfortune could possibly be our fault.

As much as we try to avoid feelings of culpability or helplessness, we are powerless — at present — to prevent our own deaths or even to escape accident. Our task is to appropriately balance risks and override the biases that lead us to make destructive decisions. This is a struggle when the benefits of inaction are diffuse and the losses are painfully personal. After all, no one wants to go up against a movement that parades small children, asking plaintively why you want to get rid of the screening protocol that saved their mommy.

This frame of thinking is destructive when applied at the personal level and catastrophic when endorsed societally. It prejudices us towards aggressive action when we ought to pause. It causes us to focus on problems that have acute manifestations rather than ongoing, but less dramatic, difficulties.

Similar errors of thinking led Time magazine to argue that the United States would be irresponsible to leave Afghanistan, since a retreat would hand control back to the Taliban. The magazine ran a cover photo of a young Afghan girl whose nose had been cut off by Taliban fighters. Her story is tragic, but Time’s bias towards the anecdotal over the structural obscured the true cost of the war. The United States is now directly subsidizing the Taliban, since aid workers and other contractors working with the military must pay enormous bribes to the Taliban in order to be allowed to operate in Afghanistan.

From breast cancer to battlefields, when we talk about policy, we must not be too much moved by anecdotes, despite our natural inclination. We must stop using words like “cold-blooded” and “calculating” to discredit scientists or policy wonks. Otherwise, we’re engaging in methodological laziness — at the cost of lives.

Leah Libresco is a senior in Jonathan Edwards College and a candidate for a Masters of Public Health at Yale.

Comments

  • jerrysmith

    Leah,

    Your editorial was excellent. I agree that sometimes it is better to do nothing. Would you apply the same reasoning to colonscopies? I had one about ten years ago and it was negative. Now I’m thinking of not doing it again. It is an invasive procedure that could be harmful.

    I notice that you will receive an MPH when you graduate and I like your ‘conservative’ (not necessarily political) views about public health issues. I would like to hear your common sense opinions down the road in opposition to some of the ‘we must do something now’ nonsense.

    Jerry Smith, 1961

  • MJG

    Loved this article! Your best yet.