Tuesday, September 19, 2006

Luck and medicine

Today's New York Times has an essay by Barron Lerner of Columbia University about the role of luck in medicine - "In Science-Based Medicine, Where Does Luck Fit In?" The piece considers how clinicians and patients interpret and explain outcomes that are different than expected, how we manage uncertainty despite strong emphasis on assessing the relevant "evidence" for a given clinical case - the broad concept of luck as a catch-all explanation for such situation -

"A more frank acknowledgment of the role luck plays has another virtue: eliminating the tendency to second-guess and blame patients... [R]isk reduction is not risk elimination. Even well-established interventions, like regular screening mammograms in women over 50 and antihypertensive pills for high blood pressure, lower the risk of death by 30 percent at most. That means that plenty of patients who are 100 percent compliant with their doctors’ wishes will still die of breast cancer or complications of hypertension, like heart attacks or strokes. These are the unlucky ones.

And then there are always those patients who constantly disregard medical recommendations and seemingly suffer no ill effects. You guessed it: lucky."
Also some brief commentary on the article at DB's Medical Rants.

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