Atypical Me

Interesting observation by Jonah Lehrer:

Just consider health care: the only way we're ever going to reduce medical costs is to restrict procedures that haven't passed evidence-based efficacy tests. Maybe that means 40 year old women don't get mammograms, or that we treat prostrate cancer less aggressively, or that we stop performing spinal fusion surgeries. Although there's solid evidence to question all of these medical options, such changes provoke intense debate. Why? Because our emotions don't understand statistics. Because when we have back pain we want an MRI. Because when it's our father with prostate cancer we want the most aggressive possible treatments. And so on.

The point is that there's often an indefatigable gap between the rigors of cost-benefit analyses and the emotional hunches that drive our decisions. We say we want to follow the evidence, but then the evidence rubs against a bias like loss aversion, and so we make an exception. We'll follow the evidence next time.

I suspect Lehrer's right on this, although you couldn't prove it by me. Having recently been through my own scenario -- in my case, prostate cancer -- I find that, looking back over the process of making a decision about how to proceed, I didn't do any of the above. First, I demanded -- and got -- a lot of information on what the indicators meant, the options for treatment, side-effects and consequences, and right down the line. (One session with a doctor lasted for well over an hour, and that was only one of several.) And then I based my decision on what I considered to be acceptable results.

Now, it may just be that I'm able to deal with my own illnesses more rationally than I can with anyone else's. I think if it had been my (hypothetical, unfortunately) boyfriend with prostate cancer, I would have been more or less in full "by any means necessary" mode. I think it's also partly due to the fact that the doctors I dealt with were very forthcoming with information, very sensible, and, perhaps, somewhat appreciative of the fact that I wanted to understand as completely as possible what was going on (which I suspect is not a reaction they meet very often). In fact, one of them told my I had a very good, positive attitude.

And I wonder, given that portion of my own history, how much of the response that Lehrer describes is due to doctors and other providers whose attitude is just the opposite.