Medical maybes

What is more delightful than finding a well-written book about a complex population health subject?  Discovering that the author is the kid brother of your elementary school roller-skating pal.

Well, you won’t get that extra kick out of reading Snowball In A Blizzard, but I did.  Dr. Hatch (really! The kid who wiped his nose on the staircase banister!) has done a fabulous job of presenting in a very readable fashion the ever-present “maybe” and uncertainty in medicine, and how we live in its limits.

For wellness promoters and supporters, the book is an eye-opener about what we can have confidence in.  Think bio-metric screening tests are helpful?  Think mammogram_imageagain.  Take mammograms for example. 

Who can forget the drama in 2009 of having fewer mammograms recommended?  In Hatch’s take, you get the warm compassion of a doctor, with the cool eye of a statistician.  The book’s title comes from a radiologist’s description of finding abnormality in a mammogram image – like finding a snowball in a blizzard.  The difficulty of discerning the snowball is the crux of why screening mammograms (especially for women under age 50) lead to more harm than good.

To this day, few give weight to the argument that wider use of the test harms more women, though this is what the science tells us.  The Affordable Care Act ignored the new recommendation, cowing to the sheer tsunami of emotion about the subject.  Science often takes a back seat to emotion in medicine.

He tackles many hot topics, ranging from statins to anti-depressants, from hormone replacement therapy to Lyme disease.  Each is viewed through the lens of what we know, how we know it, and how the unknowns shape the ends.  For example, in a chapter about statins, Hatch points out that the landmark study proving the drug’s benefit included only people who stood to benefit the most from it.  Since that time, statins have come to be used for more and more people, who have fewer of the characteristics of a high-benefit-potential statin patient.  So, we have a lot more people getting a lot less “health” from the drug and we do not know the true impact of it.

The challenges of measuring depression symptoms, the controversy over chronic fatigue syndrome treatment, and more are all fodder for the uncertainty rubric.  The narrative weaves in quotes from famous people, often on unrelated topics but germane to the issue; historical references; explanations of terms, and a good dash of humor.  Hatch seems to take his status as a doctor lightly, poking fun at lingo that is used for the sake of sounding “doctory”.  The narrative invites you into complicated subjects, reassuring you that you can indeed understand it all.

For anyone who can sacrifice the comfort of certainty, I highly recommend it.  And not just because I grew up around the corner.



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