To the Editor:
Re “New Mammogram Advice Finds a Skeptical Audience” (news article, Nov. 18):
Imagine that by screening women beginning at age 30, we could save one life for every 10,000 women screened. Should we then start screening at 30? Or imagine that by screening women beginning at age 20, we could save one life for every 25,000 women screened. Should we then start screening at 20? Probably not.
There has to be a line somewhere, and age 50 seems like a fairly reasonable place to start based on current scientific knowledge. This is evidence-based medicine in action—balancing the benefits and weaknesses of our treatments and providing effective care in a manner the evidence suggests, independent of our “gut” feelings.
Ian Goldstein
New Orleans, Nov. 18, 2009
The writer is a medical student at Tulane University.
Note from KBJ: The letter writer is wrong on two counts. First, there doesn't have to be a line. Those women who want to be screened at 40 should be screened at 40. Those who want to wait until they're 50 should wait until they're 50. Second, even if there has to be a line, it need not be drawn at 50. The letter writer gives no reason for drawing it at 50 rather than 40. He simply says that it's "a fairly reasonable place to start based on current scientific knowledge." Reasonable people disagree with that judgment; why should their judgment of reasonableness be supplanted by someone else's? By the way, I hope the letter writer practices what he preaches. He should publicly announce that he will forgo screening for prostate cancer until he is 50, and then live up to his vow.
Note 2 from KBJ: How many of you would want Ian Goldstein as your doctor? I want a doctor who puts my life and health ahead of cost containment. This New York Times letter could destroy the young man's medical career, and perhaps it should. That doesn't mean he won't have a career; it means he will have to switch to bean counting. Medicine is for people who care about each patient as an individual.
Keith Burgess-Jackson, J.D., Ph.D. 