An opinion piece was recently published in JAMA Internal Medicine with the provocative title: No wonder no one trusts us. The writer, a doctor, imagines a dialogue with a patient Mr. Jones based on the shifting recommendations of the US Preventive Services Task Force about prostate cancer screening.

Mr. Jones, receiving updated advice from his doctor that differs from the updated advice he received last time, grows predictably exasperated. (In case you are wondering, the current task force position on prostate cancer screening is: Grade C. This means there is a close balance between potential benefits and harms, and clinicians should discuss prostate cancer screening with patients, and reach individualized decisions together.)

The writer is not so much complaining about the task force as about the challenges of turning the evolving state of medical evidence into guidance patients can both understand and trust. The piece is tongue-in-cheek in any case. But still, there is a complaint being lodged, and fundamentally, its about the nature of science and the publics relationship with it.

Science evolves. And maybe thats a particular problem for Mr. Jones and Mrs. Smith and their countless counterparts in our culture because we so blithely, selectively dismiss science and replace it with GOOP as the spirit moves us. Maybe we cant disparage, dismiss and deny the science of climate change, immunization, nutrition and evolution, for that matter and appreciate the evolution of science.

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Science is something of an in for a penny, in for a pound proposition. What I mean is, you either accept the value of the scientific method, and the voluminous evidence that it works, and thus pay attention to it even when you dont like what it has to say or you really should disavow the voluminous evidence that it works. Lets be clear about that choice: disavowal means no planes, or trains or automobiles; products of science, all. It means no antibiotics or microwaves; it means no radio, television or internet. It means, quite simply, that it should not be possible for you to be reading this now.

Science works, and we all know it because we are beneficiaries of its effectiveness every day. You really cant beam well-behaved electrons through cyberspace and throw shade at science while doing it. Pick one! How easy, though, to embrace the products of science we like and renounce the conclusions we dont.

In a display of serendipity, a deadly serious opinion piece in the Annals of Internal Medicine followed the facetious one in JAMA Internal Medicine by a mere day. This one was entitled Statin Denial: An Internet-Driven Cult With Deadly Consequences, and was about the deadly consequences of statin denial. Statins are the most popular drugs for lowering LDL cholesterol, are highly effective and when used appropriately, decisively reduce mortality. In other words, they save lives.

As the commentary suggests, there are all sorts of alternative realities online, raising doubts about the benefits of statins, the value of lowering LDL, and the relevance of elevated LDL to heart disease risk.

One readily finds debate about the cholesterol hypothesis online but finds virtually no such debate among cardiologists. These alternative realities are alternatives to reality, and the commentator is right to point this out as an urgent matter of life and death. As a lifestyle medicine expert, I hasten to note that diet and lifestyle can do the job that statins do, and there are strong arguments for a lifestyle approach but thats a topic for another day. The effectiveness of lifestyle in preventing and treating heart disease does not obviate the corresponding effectiveness of statins.

That more Americans believe in angels than evolution may seem a matter of inner philosophical convictions, disconnected from real world consequences. But that is not so. Selective disrespect for science poisons the well of it, and proves toxic in surprising and intimate ways; as intimate as ones heart, prostate or uterus.

Medicine is ineluctably a bit of art, but is or should be a whole lot of science. There is no way for patients to participate as they must as key partners in the stewardship of their own health if they dont understand the basis for important decisions.

Its bad, in other words, that people dont know or respect the incontrovertible science of evolution. But that problem tends to be at least somewhat remote. Its arguably worse that people dont know or respect the incontrovertible fact that science evolves and that the evolution of science will cause medical practice and advice to drift and shift over time. Doubt and discomfort born of that is consequential up close, quite personally, and in our most intimate parts.

Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative

The rest is here:

Dr. David Katz, Preventive Medicine: Trust the evolution of science - New Haven Register