Conversations with a cab driver.

Abstract

“Hasty publications in prominent medical journals appear to provide the data used by doctors to recommend treatment.” These words were voiced by the cab driver transporting me to The Journal offices. The cab driver remarked that he had driven me in the past and remembered that I was a doctor. He informed me that he was wary of doctors because the treatment that they prescribed was usually based on inadequate and incomplete data. The driver proceeded to cite specific examples of publications that, one year, would tout a particular association as a causal relationship and then, in a subsequent year, would publish another study, often by the same authors, that completely refuted the original conclusions. The driver went on to observe that, in the haste to get information into print and the compulsion to provide the sound bite of the day, authors and journals often disregard scientific methodology and long-term follow-up. This conversation points to the sophistication of the public and our patients in relation to the medical sciences. This interest is probably the reason that articles in leading newspapers, magazines, and journals caution us to avoid drawing hasty conclusions based on inadequate data. Devotees of technology, manufacturers, consumers, those with political and personal agendas, medical societies, advocates of alternative medicine, physicians, non-physician caregivers, the media, even peer-reviewed medical journals, and “our not so gently graying baby boomers”11 are sending mixed signals in their efforts to hold onto a piece of the health-care pie. The baby boomers, reared to believe that they can retain their youthful bodies, are ably supported in this endeavor by clinicians, often belonging to the same peer group, who believe that they can reconstruct any part of the body. This generation expects to maintain the status quo—that is, to maintain the same level of physical …