Fear, Seduction, & Preventative Procedures (like Mammograms): How can we make (informed) decisions?

Fear, Seduction, & Preventative Procedures (like Mammograms): How can we make (informed) decisions?

How do we decide whether or not to undergo a, “preventative” procedure like a mammogram?

First, we might want to educate ourselves. This is trickier than it seems at first. Because many of the sources of our information may be difficult to trust.

Consider, as one of any number of examples we could explore, a July 15, 2012 New York Timescarticle, “In Vast Effort, F.D.A. Spied on E-Mails of Its Own Scientists.” Reporters Eric Lichtblau and Scott Shane write that the Food and Drug Administration (F.D.A.) conducted a remarkably far-reaching surveillance of some of their own scientists who questioned certain of the FDA’s rulings.

Here’s the meat of the thing:
“The extraordinary surveillance effort grew out of a bitter dispute lasting years between the scientists and their bosses at the F.D.A. over the scientists’ claims that faulty review procedures at the agency had led to the approval of medical imaging devices for mammograms and colonoscopies that exposed patients to dangerous levels of radiation.”

Among other possible ramifications of this example, it helps illustrate the difficulty in trusting sources in which we have often been taught to place our trust.  It suggests it might be naive to trust all decisions that emerge from the FDA, whether we are physicians or patients.

It also may be naïve to trust all information or claims coming from the manufacturers of drugs and medical devices, since they have vested interest in presenting the most positive view of their drugs or devices.

It is tough to make or trust decisions about our own health care and to make informed recommendations to our patients when we cannot trust the information upon which we base our decisions. And if trust is questionable with sources like the F.D.A or drug companies, it may be equally questionable with alternative health sources like, NewAgeFadHealthThingOfTheDay.com (um…not a real site, but it might as well be).

Let’s take the  question of mammograms, for example. We receive conflicting messages about whether to have them, how often, and whether they have side effects.

I have personally known women whose lives were probably saved by a well-timed mammogram. And I have personally known women whose breast cancer was not detected by a mammogram, even though they had them every six months. In Chapter 13 of Balance Your Hormones, Balance Your Life, I explore the practice, safety and efficacy of mammograms. I won’t get into it all here again. (But do please read that, if you are interested.) When we add to that exploration this new concern (from the F.D.A. article) about whether or not we are receiving unsafe levels of radiation with our mammograms, well…the waters get even murkier, don’t they.

What to do.

Maybe it is useful to first look at what not to do.

Whenever I am making a decision—medical or otherwise— I try to weed out fear and seduction from my motivating factors.

It is easy to let fear run the show. We may opt to receive medical tests because we are fearful of disease. Or fearful that we will look irresponsible if we don’t. Conversely, we may opt never to receive them because we are fearful of their side effects, or fear our friends will think we are doing the, “wrong” thing.

It is also easy to be seduced into thinking a procedure is more effective than it is, simply because we want them to be. Or to think that a, “preventative” measure will keep us from getting a disease. (Here it may be good, in this context, to remember that these procedures are often not preventative at all. Early detection is not the same as prevention.) Or, conversely, that our friends will think we are cooler or wiser if we do not get it.

I have found neither fear nor seduction to be solid cornerstones of a wise decision. I explore the question of what are valid forms of knowledge, and decision-making in more depth in Part I of The Four Qualities of Effective Physicians: Practical Ayurvedic Wisdom for Modern Physicians.

What to do.

In sanskrit the word for “healthy” is “svastha,” which means to, “be established in one’s self”. If we take external circumstances and information into consideration, then look inside ourselves quietly for what is right for us, our final decision is informed from within, as cliché or corny as that may sound.

There are no guarantees in medicine. So, for myself, I become as educated as I can. If there are two or more differing perspectives on the issue at hand, I like to become as educated as I can on each of them; to weigh the situation as clearly as I can, (yes, even in the face of the fact that I may not have accurate information about risks, etc.), try to discard my (and others’) fears and seductions, look inside for my own inner clarity, and then have the courage go with that clarity. And not look back.

And. If there is no clarity, to have the courage to wait. One of my teachers used to say, “When in doubt, do nothing.” I have found this to be a powerful personal tool. I find that, if I have no clarity on something, if I wait, the situation does become clear.

Sometimes it takes more courage to wait than to act. I have found that exercising trust, while  waiting, to be useful.

My guru used to say that it is better to dig a well before you get thirsty. It is similarly useful to practice listening within before we are in crisis. This is why the practice of meditation–going within, is an important part of the Ayurvedic practice of dinacaryā (a healthy daily routine). Then, when we need to find clarity within, we have a daily, established practice of doing so, into which we can tap.

We can start by taking some full, slow breaths. Gratefully, they come with zero negative side effects.

This post is repurposed and edited, from a blog Dr. Welch originally posted on 16 July, 2012.
Copyright Dr. Claudia Welch 2012

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