LYMEPOLICYWONK: Groopman: Who Knows Best—a Lesson for Lyme
First, do the experts really know what’s best? Groopman explains the fallacies of mandating best practices: “Over the past decade. . . experts . . .have repeatedly identified “best practices,” only to have them shown to be ineffective or even deleterious.” He points as examples to best practices in the areas of blood sugar levels in intensive care, knee and hip replacement, control of asthma, diabetes, hypertension, and pneumonia. Groopman goes on to identify factors that doom “best practices” guidelines: 1) failure to separate those practices that can be standardized (like safety) from those that require individualized care, 2)”overconfidence bias, the tendency of experts to overestimate their ability to “analyze information, make accurate estimates, and project outcomes,” 3) “confirmation bias,” the tendency of experts to “discount contradictory data”, and 4) the fact that clinical trials yield averages that don’t reflect clinical reality of patients with multiple medical conditions or at varying stages of disease progression.
Second, do decisions between treatment choices belong to the patient? Take the mammogram controversy. The recent change in those guidelines caused an uproar. One argument in favor of increasing the age limit for mammograms was to “spare [women the] anxiety, distress, and unnecessary biopsies”. NPR commentator Block hit the nail on the head when she identified this as “a very patronizing approach to take toward women’s health…. Women may very well be willing to assume those harms if it means that they may be diagnosed earlier.” Thaler, coauthor of Nudge, analyzed the mammography controversy in The New York Times and concluded that “one can make a good case that we don’t want the government making these choices” for us. That is essentially what the Lyme community has been saying to the IDSA for years.
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You can follow additional comments on Lyme policy at www.lymepolicywonk.org. You can contact Lorraine Johnson, JD, MBA at lbjohnson@lymedisease.org.
