by Steven Hatch
Joint National Committee (JNC) debate on blood pressure targets in, 89, 90–92, 93–94, 98, 216
JNC8 and JNC7 guideline differences of, 90–91, 91 (table), 215–216, 217, 230
reclassification for blood pressure targets by, 91–92, 91 (table)
Journal of the American Medical Association, 230
Journal of the National Cancer Institute, 35, 36 (fig.), 73
Kahneman, Daniel, 20, 23
Katie, 191, 192, 197–199, 200, 204–205
Kelsey, Frances Oldham, 161
Kershaw, Glenn, 98
kidney cancer, 36 (fig.), 37
kidney disease, 90–91, 91 (table), 216
Kitch, Barrett, 234–235
knee replacement, 206–208
Krugman, Paul, 181
Lind, James, 130–133, 135, 137, 140, 146, 245–247
Lipitor, 17, 138
London Hospital, 3–4
Long, Monica, 81–82
lump, breast, 50, 58, 65, 74
lung cancer, 15
CT scans and, 259–260
screening tests for, 34, 259
smoking and, 1, 34, 154–155, 256–257
Lyme disease, 13
alternative and mainstream medicine on, 103, 104–105, 111–112, 113–114, 115–118
antibiotics for, 100, 102, 103, 111, 114–116, 119, 123, 125–126, 256
antibodies and testing for, 107–110
arthritis and, 105–106
bacteria discovered in, 106
bias with diagnosis of, 113–114
chronic fatigue syndrome link to, 100, 105, 124, 256
diagnostic tests for, 102–103, 106–110, 111–112, 126
drug and insurance industries and, 120–121
false-negative with testing for, 110–111
false-positives with testing for, 108–109
geographical occurrences of, 103
guideline review for, 121–123
illness with, 100, 102, 105–106
Internet and controversy on, 102–103, 105, 119, 123–124
media on, 117–118
overtreatment with, 111, 113
patient example with, 100–102, 124–125
test interpretation debate for, 107, 111–112
treatment debate for, 16–17, 100, 115–117, 119–122, 124–125, 223
uncertainty with, 112–114, 223
See also tick-borne illness
“mainstream” medicine, 103, 104–105, 111–112, 113–114, 115–118
mammogram
of breast cancer, 72 (fig.), 73
with known lump, 50, 58, 65, 74
mammography, screening
absolute compared to relative benefit of, 77–79
accuracy in, 70
age and, 66–67, 69, 74, 75, 76–77, 83–84, 88, 221
Canadian trial on, 83–84, 88, 249
controversy over, 10–11, 51, 54, 59–60, 85–86, 88, 99
data on, 61–62, 64–65, 66–67, 82–83
diagnosis rates and, 37
diagnostic test compared to, 58, 65–66, 74
false-positive errors in, 16, 67–68, 69 (fig.), 75, 221–222
harm with, 12, 58, 69 (fig.), 74–76, 83
HIP study for, 77–78
media on, 59, 62–64, 73, 81–84
moral issues with, 64
predictive value with, 56, 73, 241
psychological factors in, 69 (fig.), 70, 74
recommendations by “Grade” for, 80, 222, 229–230
risk and benefit of, 77–79, 83–84, 88
symptom absence with, 50, 58, 65–66
tumor detection in, 72–73, 72 (fig.)
uncertainty with, 65, 73, 84, 86, 88, 221
USPSTF guidelines on, 58–59, 60–62, 66–67, 69 (fig.), 75–77, 80, 82–88, 222, 229, 241
women’s reactions about, 59–60
yearly compared to biennial, 75–76
Marshall, Mallika, 192, 199
media
on chocolate benefits, 170–171, 228
clinical research distortion by, 205–206
controversy creation by, 189–192
correlation/causation problems and, 166
coverage of HIV “cure,” 182–185, 189, 204, 227
coverage of rare viruses, 201–202
evidence lacking in, 228–229
on exercise, 203–204
health coverage reviews, 206–210, 230
health threats magnified by, 201–202
on heart disease, 204
on hormone replacement therapy, 173, 175, 177
on HPV vaccine, 191–193, 197–200, 204–205
on Lyme disease debate, 117–118
on mammography debate, 59, 62–64, 73, 81, 84
narrative fallacies in, 20, 200
public health knowledge and, 17, 151, 178, 181–182, 200, 225–226, 228–229
research language used by, 205–206
sources of health news in, 185
uncertainty ignorance of, 184, 186, 189, 204–205, 226–227
medical “manufactroversy,” 188–190
medical pioneers, 2, 5–6
medical-industrial complex, 84, 134
medications. See drugs
melanoma, 36 (fig.), 37
menopause, 172–173, 175–176
Merck, 191, 193–194
MERS, 201–203, 205
Mevacor, 138, 139, 142
Mlodinow, Leonard, 16, 53, 54–56, 58, 67–68, 108
Mnookin, Seth, 190, 225
modern medicine, 19
clinical research structure in, 131–133
drug trial structure in, 133–134, 247–248
global adherence to, 4–5
history of, 2–4
narratives of, 21–22
regulation in, 2–3
two-prong approach in, 23
uncertainty in, 5, 127
Monsees, Barbara, 222
mortality rates. See deaths
MRIs, 24
narratives
fallacy in, 20, 200
of modern medicine, 21–22
uncertainty and, 19–22
National Cancer Institute, 35, 36 (fig.), 73, 77
national health guidelines
controversy over, 10–11, 51, 54, 59–60, 85–86, 88, 99
“Grades” of recommendations in, 80, 222, 229–230
Lyme disease debate and, 121–123
physicians’ adherence to, 96
public relations for, 85–86
for statins and cholesterol, 145, 249
uncertainty with, 98
use of, 58, 63
See also Joint National Committee; US Preventive Services Task Force
National Heart, Lung, and Blood Institute, 89–90
National Institutes of Health (NIH), 118, 119, 176–178, 251
NBC News, 63, 81, 84
Neurontin, 174
New England Journal of Medicine, 118
on DES case series, 159, 160 (fig.)
on drug trials, 148
on hormone replacement therapy, 173
HPV vaccine and, 194
on Lyme disease treatment, 116
on statin therapy, 145
New York Times, 212, 230
Berlin patient coverage by, 185
on breast cancer, 81
on chocolate benefits, 170–171, 228
on exercise, 203–204
on hormone replacement therapy, 175
on Lyme disease treatment, 117–118
on mammography, 59, 74
NIH. See National Institutes of Health
Nixon administration, 35
null hypothesis, 246, 255
Ockene, Judy, 84–86
oncologist, 7–8, 213
opiates, 128, 137
Orwell, George, 99
overdiagnosis, 23
bias in, 133
of breast cancer, 75
cancer rates and, 35–39, 36 (fig.)
with CT scans, 45,
259–260
diagnostic technologies and, 24–25, 46, 50
education and, 37
harm with, 16, 34, 50
human evolution and, 32–33, 50
overtreatment from, 46–47
of PE, 45, 46–47
profits in, 49–50
psychological factors in, 42
in screening mammography, 57–58
statistics and, 42, 75
uncertainty’s role in, 38–39
overtreatment
with Lyme disease, 111, 113
overdiagnosis leading to, 46–47
profits in, 49
Oz, Mehmet, 252
p value, 244–245
The Panic Virus (Mnookin), 190, 225
patient
family deciding for, 219–220
risk and benefit understanding of, 214–215
patient/doctor model
communication in, 48, 98, 214–215, 231–233
equity in, 212–217, 220
paternalism in, 212
patient autonomy in, 19, 212, 220
uncertainty disclosure in, 216
PE. See pulmonary embolism
Pearson, Cynthia, 153, 175
Phase III studies, 193–195
physicians
family communication with, 7, 149, 219
as guide, 211–212, 220
health guidelines influence on, 96
humility importance in, 213, 214, 220
media health coverage reviewed by, 206–210
patient communication with, 48, 98, 214–215, 231–233
SSRI prescriptions from, 148–150
uncertainty with, 5, 48, 57, 216, 230–231
See also patient/doctor model
placebo controlled research, 132–133
placebo effect, 92–93
PLoS Medicine, 208–209
politicians
on mammogram debate, 59
screening tests advocacy by, 6
treatment advocacy by, 17, 119–124
Pollan, Michael, 14
poppers theory, 164–165
Porter, Roy, 3, 130
predictive value
accuracy of tests and, 55–56, 259
with screening mammography, 56, 73, 241
pregnancy, 157–159, 160 (fig.), 161–163
Preston, Richard, 202
probability, 7–8, 55–56, 58
profit
drug industry and, 22, 49–50, 121, 150, 172–173, 251
in overdiagnosis, 49–50
with statin drugs, 137–138
prognosis, 7–8, 213
ProMED, 200–201
prostate cancer
diagnosis compared to deaths in, 36–37, 36 (fig.), 38, 39–40, 40 (fig.)
screening debate for, 39–40, 40 (fig.)
prostate specific antigen (PSA) test, 13, 37, 39–40, 53–54
Prozac, 17, 139, 146
Prozac Nation (Wurtzel), 139
PSA test. See prostate specific antigen test
pseudodisease, 33–34, 41, 49
psychiatry
diagnosis in, 25–31
drugs prescribed in, 21, 148
psychological factors
in false-positive biopsies, 81
in overdiagnosis, 42
in screening mammography, 69 (fig.), 70, 74
of screening tests, 39, 41
public health
government programs for, 35
media coverage reviews for, 206–210, 230
role of media and Internet in, 17, 151, 178, 181–182, 185, 200, 225–226, 228–229
threats magnified by media, 201–202
See also national health guidelines
pulmonary embolism (PE), 42–47, 46 (fig.)
radiation
breast cancer treatment with, 79, 82
CT scans and, 260
side effects of, 41
in X-rays, 70–71
radiology, 10, 73
randomness
in clinical research, 133, 245–247
statistical significance and, 242–247
rational drug design, 1
reification, 42, 47–48
retrospective research, 154–155, 158–159, 160 (fig.), 162–163
risk and benefit, 9
of antidepressant drugs, 149
with blood pressure targets, 91–92, 94–98
confidence in, 11–13, 11 (fig.)
disease severity and ratio of, 216–217
of drugs, 151, 177–178
with hormone replacement therapy, 176–177
patient understanding of, 214–215
with PSA test, 13, 39–40, 53–54
relative compared to absolute, 77–79, 214–215, 219
of screening mammography, 77–79, 83–84, 88
in statistical significance, 259
in treatments, 153
of vaccines, 193–194, 223–225
Rosenhan, David, 26–29
Rosenhan experiment
cancer diagnosis compared with, 34, 38
details of, 25–28
diagnostic errors in, 29–30
Rumsfeld, Donald, 1, 14
Russell, Bertrand, 57, 64
Saint John’s wort, 251
salicylic acid (aspirin), 128, 137
SARS, 201–202
Saul, Stephanie, 81
schizophrenia, 9, 25–26
Schwitzer, Gary, 206–209, 230
Science, 25
scientific method, 130
screening tests
accuracy of, 54–55, 70
for cancer, 65–66, 190–191
diagnostic compared to, 58, 65–66
for lung cancer, 34, 259
modern, for HIV, 56, 68
mortality rate and benefit of, 78
for PE, 43–45
politician advocacy of, 6
profit in, 49
psychological impact of, 39, 41
symptom absence and, 50
See also mammography, screening; prostate specific antigen test
Scully, Robert, 156–157
scurvy, 129–133, 135, 137, 140, 142, 245–247
SEER. See Surveillance, Epidemiology, and End Results program
senna, 128, 137
sexually transmitted virus, 191
SHEP. See Systolic Hypertension in Elderly Patients trial
side effects
of antibiotics, 6, 116
of biopsies, 39, 260
of cancer treatment, 39–40
of drugs, 145, 248
of radiation, 41
Siegel, Marc, 202
The Signal and the Noise (Silver), 10
Silver, Nate, 10
smoking, 184
CT scans and cancer with, 260
disease from, 15, 225–226
lung cancer and, 1, 34, 154–155, 256–257
SSRIs, 17, 139, 147–150
standardization, 168, 171
Staphylococcus aureus, 115
statin drugs, 17, 225
clinical trials for, 140–145, 176–178
guidelines for, 145, 249
profit with, 137–138
side effects of, 145
success of, 138–139, 149, 249
statistical significance
categorical and continuous variables in, 242, 254–256
control group and, 245, 248, 257
p value for, 244–245
participant pool size for, 246–247
randomness and, 242–247
risk and benefit in, 259
statistics, 20
on blood pressure levels, 91, 249
books on, 242
on breast cancer, 67, 75–76
on cancer, 7–8, 34–37
coin flip example of, 243–245
HIV test, 54–56
illusions in, 42
on infection rate for HIV, 182, 259
null hypothesis in, 246
overdiagnosis and, 42, 75
&nbs
p; p value in, 243–245
on screening mammography, 83–84, 88
See also data and evidence
stethoscope, 2
streptomycin, 133–134, 247–248
Stricker, Raphael, 118–119
strokes, 92, 95
studies. See clinical research; drug trials
suicide, 146
superfoods, 252
surgeries, 41, 69 (fig.), 75, 81–82
Surveillance, Epidemiology, and End Results program (SEER), 35
Systolic Hypertension in Elderly Patients trial (SHEP), 92–95
Taleb, Nicholas Nassim, 10
TB. See tuberculosis
thalidomide, 161–162
thyroid cancer, 36 (fig.), 37–38
tick-borne illness, 104, 105–106, 112
treatments
benefit and risk in, 153
confidence in, 11–13, 11 (fig.)
harm with, 48–50, 89, 100, 113, 223
impact variability with, 135
politician advocacy of, 17, 119–124
uncertainty in, 16–17, 181, 223
See also cancer treatment; Lyme disease; overtreatment
trials. See clinical research; drug trials
tuberculosis (TB), 115, 125, 247–248
TV. See media
ultrasound, 37
uncertainty
with biopsy, 75–76
communication about, 230–231
with diagnosis, 5–6, 9, 181
with drug trials, 17, 136–138, 140–141, 153–154
early and modern medicine with, 5, 127
empowerment with understanding of, 18–19, 96, 182, 210
error management theory and, 32
among experts, 88–89, 98
family’s understanding of, 13, 18
Grade I and, 222, 229
with herbal remedies, 250–253
in ICU, 218–219, 231–233, 235
with Lyme disease, 112–114, 223
manifestation of, 6–7
media’s ignorance of, 184, 186, 189, 204–205, 226–227
metaphor for, 9
narrative and, 19–22
with national health guidelines, 98
overdiagnosis and, 38–39
physician awareness of, 5, 48, 57, 230–231
physician disclosure of, 216
in prescribing drugs, 149–150, 153
Rumsfeld quote on, 1, 14
with screening mammography, 65, 73, 84, 86, 88, 221
spectrum of, 11–13, 11 (fig.), 100, 162, 193, 221
as tool, 58, 96
in treatments, 16–17, 181, 223
with Western blot test, 110
See also certainty
underdiagnosis, 32–33
US News & World Report, 206–207–208
US Preventive Services Task Force (USPSTF)
creation of, 63
mammogram guidelines of, 58–62, 66–67, 69 (fig.), 75–77, 80, 83–88, 222, 229, 241
on PSA testing, 40
women members of, 61–62, 84–86
Vaccine Adverse Events Reporting System (VAERS)
example report from, 196–198
HPV vaccine data in, 193–194
reliability of data from, 195–196, 199