Mark Cuban vs. guideline writers

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Who can do the most harm?

Celebrity Mark Cuban set off controversy a few days ago with a Tweet expressing his recommendation that people should get quarterly blood tests “for everything available.”  If you have not followed the story, you can quickly get up to speed by reading a couple of posts on Forbes.com written specifically about this opinion firestorm.

Apart from their disagreement with Cuban’s specific recommendation, many physicians seemed particularly concerned that he and other celebrities who express medical opinions exert undue influence on the public.  In my opinion, this concern is misplaced.

Rather than be distracted by celebrities we claim we should not pay attention to, we should be more worried about the influence wielded by the small cadre of medical academics that routinely issue clinical guidelines.

For example, a dozen guideline writers—many of whom have strong ties to the pharmaceutical industry—can decide for the entire nation what a normal blood pressure should be or where to set the cholesterol target.  When a new guideline recommendation causes millions of new patients to materialize overnight, the writers take no responsibility for their action, even if a subsequent guideline retracts the advice of the previous one.

Many of our medical authorities have influenced countless post-menopausal women into taking hormone replacement therapy.  Yet, when the empirical data established the harm of these drugs–a harm suspected by more astute and circumspect clinicians, none of the original influencers apologized or had their career threatened in any way.

Other medical personalities with close ties to government health care programs make a career out of writing editorials that claim we over treat and over test.  But when they issue their “less is more” opinions, these experts invariably claim “no conflict of interest.”

In our highly centralized health care system, a medical nomenklatura beholden to no one can determine medical outcomes for millions of patients they have never met.  It is their influence, not Cuban’s, we should be worried about.

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