The Sky Is Falling!

We are in an age of medical hyperbole. Consider the following recent announcements in the media:

• Medscape: Alcohol at any dose increases your risk for cancer!
• Consumer Reports: Spray suntan lotion is bad for your kids!
• New York Times: Eat more fish or your kid will be at risk for a lower IQ!
• NPR: Zoloft may make your teenager suicidal!
• AMA: Obesity is a disease!
• Jenny McCarthy: Vaccines cause autism!
• AARP: Don’t touch our Medicare!
• NRA: Obama wants to take away our guns!
• Conservative Christians: Abstinence only!

Come to think of it, we’re in an age of hyperbole in general. Dick Cheney says in The Wall Street Journal, “Rarely has a U.S. president been so wrong about so much at the expense of so many.” Bill Gates calls US immigration laws “Bad. Really, really bad. I’d say the treatment of immigrants is one of the greatest injustices done in our government’s name.” A salon.com article announces “Honey Boo Boo is a monster.” And speaking of TV, the American Academy of Pediatrics says no child under age 2 should watch TV. Ever. The Vatican says that homosexuality is an absolute sin, no exceptions. Jimmy Fallon says “he/she is the best!” on practically every episode of The Tonight Show.

Medicine seems to be especially vulnerable to emphatically expressed blanket statements. After all, a multimillion-dollar industry and a thousand websites have been created to tell women what they can and cannot do while pregnant. Another business, equally lucrative, revolves around breast cancer screening. Then there’s the diet industry, GMO proponents, superfoods, and gluten-free pasta at Del Posto, the expensive New York Italian eatery. Everyone is telling everyone else what to do, and saying it in a way intended to scare us into compliance.

Some of this advice comes from good science and some relies on questionable data. Evidence is incontrovertible, except when it’s not. Hyperbole can be driven by fear of litigation, or death, or social disapproval, or a less-than-perfect child. It is usually motivated by emotion, not reason, and drags with it all the core beliefs, politics, and fears of the one proclaiming the Absolute Truth as they see it. Remember in the movie Tangled, when Rapunzel asks to go see the lanterns and her mother says, “You are not leaving this tower! Ever!”? That mother’s statement came with a whole raft of personal beliefs and biases, not the least of which was the preservation of her own youth.

There are voices of reason, but they get quickly drowned out by people who have already made up their minds. Remember when the U.S. Preventive Services Task Force came out with breast cancer screening recommendations? Women started yelling that the government wanted to take away their health care.

As doctors, we have a responsibility to calm the masses. Indeed, our patients look to us for the data to help their decision-making. But they also look to WebMD and Google. It is very important that we not feed the fires of any extreme belief, no matter what our politics or personal beliefs. It is our duty to present the data and the options honestly and without bias. This requires communication, understanding, and time, things we are not generally paid for. Absolutes are always dangerous. “Never” and “always” should not be words that we use. The pediatrician who prescribes only abstinence to his teenage patients, or the gynecologist who insists on yearly pap smears for everyone, or the obstetrician who never allows VBACs: all these physicians do a disservice to patients and to medicine. They are putting their biases before their work.

What would have happened to Rapunzel and her mother if they had sat down and had a frank discussion about hair and longevity? “Honey, I’ll let you see the lights but please don’t cut your hair or get captured by bad guys because you are the source of my eternal youth and I really don’t want to get old.” “Jeez mom, why didn’t you just say that instead of getting all crazy and rigid?” See?