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What Constitutes Evidence? Colorectal Cancer Screening and the U.S. Preventive Services Task Force

Lerner, Barron H; Curtiss-Rowlands, Graham
The United States Preventive Services Task Force is perhaps America's best-known source of evidence-based medicine (EBM) recommendations. This paper reviews aspects of the history of one such recommendation-screening for colorectal cancer (CRC)-to explore how the Task Force evaluates the best available evidence to reach its conclusions.Although the Task Force initially believed there was inadequate evidence to recommend CRC screening in the 1980s, it later changed its mind. Indeed, by 2002, it was recommending screening colonoscopy for those aged 50 and older, "extrapolating" from the existing evidence as there were no randomized controlled trials of the procedure. By 2016, due in part to the use of an emerging analytic modality known as modeling, the Task Force supported four additional CRC screening tests that lacked randomized data. Among the reasons the Task Force gave for these decisions was the desire to improve adherence for a strategy-screening healthy, asymptomatic individuals-that it believed saved lives.During these same years, the Task Force diverged from other organizations by declining to advocate screening otherwise healthy Black patients earlier than age 50-despite the fact that such individuals had higher rates of CRC than the general population, higher mortality from the disease and earlier onset of the disease. In declining to extrapolate in this instance, the Task Force underscored the lack of reliable data that proved that the benefits of such testing would outweigh the harms.The history of CRC screening reminds us that scientific evaluation relies not only on methodological sophistication but also on a combination of intellectual, cognitive and social processes. General internists-and their patients-should realize that EBM recommendations are often not definitive but rather thoughtful data-based advice.
PMID: 35428902
ISSN: 1525-1497
CID: 5219172

Judging Medicine's Past: A Lesson in Professionalism

Lerner, Barron H
PMID: 34126029
ISSN: 1539-3704
CID: 4924632

Health Care in America: A History [Book Review]

Lerner, Barron H
ISI:000406568700016
ISSN: 1086-3176
CID: 2677042

Judging the Past: How History Should Inform Bioethics

Lerner, Barron H; Caplan, Arthur L
PMID: 27802464
ISSN: 1539-3704
CID: 2296512

Judging the Past: How History Should Inform Bioethics

Lerner, Barron H; Caplan, Arthur L
Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the "bad old days" of physicians behaving immorally. Bioethical discourse-both in the classroom and in practice-should be accompanied by efforts to historicize but not minimize past ethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.
PMID: 27089070
ISSN: 1539-3704
CID: 2098172

Moving Past Individual and "Pure" Autonomy: The Rise of Family-Centered Patient Care

Igel, Lee H; Lerner, Barron H
PMID: 26854637
ISSN: 2376-6980
CID: 1936982

Euthanasia in Belgium and the Netherlands: On a Slippery Slope?

Lerner, Barron H; Caplan, Arthur L
PMID: 26259038
ISSN: 2168-6114
CID: 1721622

Searching for Semmelweis

Lerner, Barron H
PMID: 24449943
ISSN: 0140-6736
CID: 782672

Policing online professionalism: are we too alarmist?

Lerner, Barron H
PMID: 23979294
ISSN: 2168-6106
CID: 598412

Well [New York Times Blog], March 7, 2013

Film Festival Explores an Ugly Medical Chapter

Lerner, Barron H
(Website)
CID: 242392