Medical Misadventures

On Friday, Mr Litlove fell off his bike on his journey to work. He was rounding a corner when the bike slowly slipped from under him, and it wasn’t until he was on the ground that he saw the sheet ice. A couple of builders working nearby came over to check on him, but by then Mr Litlove was back on his feet and brushing himself down and being thankful he hadn’t broken any bones. He’d bruised his ribs and his hip, though, and when he limped in on Friday evening after work, he was clearly a man who had sustained injury and wanted some sympathy. Need I say more?

‘So you won’t be going rowing in the morning, then?’ I asked him.

Mr Litlove’s eyes slid away from mine. ‘I expect I’ll be fine,’ he said.

And so of course, the stubbornness of the male being unparalleled, he was up at 6 am and off to the river. And then we went out to lunch, so it’s possible that he overdid things a tad because by Sunday he was very stiff and sore indeed.

I was expecting a skype call with our son that morning. He has an essay paper to do this year and I offered to lend a hand, given that he’s not written one in several years. The topic is science communication, which turns out to be rather fascinating. It’s a jolly good idea for the public to have some notion of what science is up to, but as with all these vague mission statements, things become tricky when we actually get down to nuts and bolts. How much information do we need to have any sort of useful judgement about current developments in science and technology? Who needs to know? And who is going to tell us in the ‘right’ way? When scientists talk about public understanding, what they often mean is public appreciation – getting the power of mass influence behind their research in order to secure more funding. Whereas what often happens is panic or aversion thanks to sensationalist and inaccurate media stories.

Let me give you a little example of some of the issues involved. Back in the 1950s a medical researcher, Alice Stewart, started to collate the figures on infant deaths by leukemia in women who had been x-rayed during pregancy. The statistics spoke for themselves; up to a child a week was dying from the disease and the mortality rate was almost 40% higher in children whose mothers had been x-rayed. Stewart published her findings in the Lancet in ’56, in the British Medical Journal in ’58 and yet the Medical Research Council absolutely refused to accept her conclusions. Stewart was a lone female voice without the backing of a large organisation. Doctors were in love with the technology, which they believed could only be useful. They were unwilling to take any one else’s word on a problem they had not identified themselves – the more authority at stake, the more unwilling people are generally to admit mistakes. And finally, they believed that as doctors they were always healing people; they simply could not hear the opposite. Too many cherished assumptions needed to be overturned and so for the next 25 YEARS doctors continued with the x-rays, and thousands of children died.

Science needs to be in the public eye, because keen public observation keeps people more honest. And the general public is a useful moral barometer, reacting strongly when science moves into territories where ethical issues are complex. But then we have to think about the scares over the MMR vaccine, which were sparked by one set of results that have since been called into question. The real problem is in the calculation of risk, which we are not encouraged by the media to do with any pragmatism. And anyhow, when our health or that of loved ones is at stake, it’s hard to be cool-headed.

I have an interesting calculation of risk of my own underway at the moment. Last week an invitation from the NHS popped through my letterbox to attend a cervical smear test. Oh joy. It’s not the test itself that bothers me, it’s the inaccuracy of the results. One in twenty women screened will register a false positive and have to go through an unpleasant medical procedure in consequence. One in twenty is a lot. On any given day, assuming a 50/50 gender split, ten women will read this blog who have been scared and treated invasively for no reason at all. I’m tending to agree with Germaine Greer on this one.

I readily confess that I am not good with medical procedures – a touch phobic, for sure. And I am terrified by the prospect of falling ill again, having so recently regained (most of) my health from the worst of chronic fatigue. Am I sensible about this? No, of course not. I had a bad viral illness and it took me 13 years to get over it. How could I possibly be sensible after that? But I know for sure that the stress and anxiety over the test and a false positive result would result in another stretch of chronic fatigue for me. More months lost to illness, when I’ve lost too many already.

Don’t worry; I am the least reckless person you’ll ever meet and I daresay I’ll go and talk it through with my nice doctor. But I have a little fable involving Mr Litlove to tell you about. When I expressed my displeasure at the arrival of the summons, Mr Litlove sighed and clearly wanted to say something he thought better of.

‘You think I should go and have it, don’t you?’ I asked.

‘Well yes, I suppose you should just get it over with,’ he replied.

‘You men should try it once in a while. Some sort of unpleasant, embarrassing test with an uncertain outcome. Something that involves shaving your balls and having them weighed or some such. How many men would do that?’

‘Oh don’t make me laugh,’ said Mr Litlove, clutching his sore ribs. ‘Please don’t. It hurts.’

‘And that reminds me. If those ribs are no better on Monday morning, you should go to the hospital and get an x-ray.’

The look on his face was transparent. It said: NO WAY.

‘Casualty won’t be too bad on Monday morning, I expect.’

‘My sister’s coming to stay on Monday,’ Mr Litlove mumbled. ‘I’ll ask her.’

Back in the day his sister was a GP and now works in academia in public health, none of which to my knowledge has gifted her with x-ray vision. But this is typical. He’ll tell me soon enough what to do, but he’d rather walk around with cracked ribs than go to a doctor. What has understanding science got to do with our behavioural choices, I wonder?

 

 

 

 

 

22 thoughts on “Medical Misadventures

  1. Poor Mr. Litlove! But poor you too! I can empathise – I go into denial when anything medical is involved and have to be forced to go to my diabetes checks. I think I’ve spent too long hanging around in hospitals watching people who don’t seem to know what they’re doing or care either; OH has an ongoing condition which has been there for nearly 10 years and no-one has even managed to diagnose properly. So yeah – I don’t like medical stuff….😦

  2. We’re in sore need of people who can accurately translate scientific and medical reports to the rest of us. Take last week’s scare about the link between dementia and both prescription and over the counter medication, hysterically reported by the tabloids and only a tad less so by Radio 4 and the broadsheets. The NHS posted a rather tetchy debunking of much of it on their website.
    I do hope Mr L’s ribs are a little easier today.

    • Or the recent story (Telegraph et al) “Woman on top” being the most “dangerous” position for heterosexual intercourse. A classic example of not understanding relative risk, or at least not letting it get in the way of a “good story”🙂

  3. Sorry to hear about the medical misadventures. MMR was an appalling outcome including some dreadful journalism from people who should have known better. The medical evidence was always so clearly in favour of the vaccination but that didn’t make for anything like as good “copy”; I was particularly dismayed by the way Private Eye covered it. If Wakefield had been ethical enough to disclose his numerous conflicts of intrest then perhaps everone might have been better served.

    Regarding X-rays, I cannot comment as I don’t know the background but (as my wife knew well in her days in casualty and as a GP) patients themselves can be extraordinarily demanding of unnecessary treatment (see also antibiotic overuse) and it is not easy always to persuade those who are ill and in pain. I do wonder if the placebo X-ray machine might not have been a good idea.

    As a scientist keen to increase anyone’s understanding (and no doubt increase my own visibility at the same time too) I am always thinking about how to do it and whether anybody on the other side really benefits. Does publicly presenting my work to a lay audience keep me honest? To be truthful it is presenting it to the steely gaze of other colleagues, anonymous journal referees and funding agencies (and hopefully some level of ethics in myself) that does that.

    Bayesian statistics taught to everyone at school might do a great deal to help all of us understand the issues of false positives and the importance of stating clearly your prior knowledge when working out significance. I wonder if Mr Gove’s successor might include that along with the twelve-times table in our brave new school world?

  4. Oh this made me laugh! I have had similar conversations with Bookman regarding the “summons.” When I went last fall my doctor decided to be worried about a uterine fibroid that had gotten bigger in the three years since my last exam and even though I was having no problems or symptoms of any kind she sent me off to an ultrasound which turned into something rather invasive and unpleasant and this other doctor ended up saying, you have a fibroid and no problematic symptoms so it’s nothing to worry about. Then charged me several hundred dollars for all the fun. Bookman just could not understand why I was so very angry about it all. I’ll be keeping my fingers crossed for you. As for Mr. Litlove, I hope his ribs aren’t broken.

  5. I do so enjoy reading your stories – but do hope that Mr Litlove hasn’t hurt himself badly. (Equating smears with checks for an enlarged prostate usually does the trick to explain how ghastly the whole thing is I find).

    More seriously though, I would encourage you and your son to read Bad Science by Ben Goldacre – it’s very illuminating and very readable. It’s sad though that for every Alice Stewart there is at least one Andrew Wakefield (he of the MMR scare) – and it is not always straightforward for the experts, let alone the public, to always see what is good science and what is bad. (Love your comment about funding though – made me chuckle.)

  6. So typical–I’ve had experiences like that at my end. But I can’t say it’s exclusively male. My mil almost certainly had congestive heart failure for at least a year and hadn’t been to the doctor about it because when she didn’t feel well she didn’t like to go out. On another note, that story about Alice Stewart is fascinating–I wasn’t aware of it.

  7. I empathise with you on the false positive issue as it’s something I worry about too when the letters for these tests drop through my door. It’s difficult to know what to do for the best and I can understand your anxiety over the outcome of any tests. Wishing you all the best whatever you decide to do…

    I hope Mr Lit Love’s ribs are a little better today!

  8. Much food for thought here—and I think we see this not only in medicine, but just in general; the hard facts of science, even when they are easily proved, don’t necessarily impact behavior in any way that makes sense…witness the number of people who will drive under the influence of perception-altering substances, though it’s pretty easy to see that this is a dangerous thing to do, and the number of accidents and deaths resulting from it are statistics readily available.

    I get what you mean about the test, though not in literal parallel, obviously…but a problem in the same category was what kept me away from the dentist for four years; I couldn’t risk the destabilization that would result. Even $14K worth of dental work later, I actually don’t regret that choice, but of course, it also wasn’t a question of detecting something life-threatening…though toward the end there, it sure as hell felt like it.

  9. I’m so tremendously relieved that the lovely recent guidelines on pap smears have announced we only have to have them every few years. They’re such a misery, and I am always very nearly overcome by the impulse to kick. (I am a brat that way.)

    Glad nothing terrible befell Mr. Litlove on his tumble from the bicycle!

  10. My policy on going to doctors (exacerbated by minimalist US health insurance) is to wait approximately 2 years longer than possible and only then succumb to treatment.

  11. You can’t split gender if men are not getting Pap smears, which last time I checked, they aren’t. So the fraction is still indicating that 19 of 20 women are getting good or bad news accurately. The twentieth one can get a second opinion. You’re trying to argue against an unknown, which is 19 times rarer than the known. Get the damn test done because we dig you, and want you around; you better our lives. Besides, it’s not nearly as invasive as cancer.

    Now as for you, Mr. Litlove (wagging finger), this is the second time I’ve had to ask if you’re okay. Two too many. Please heed your body’s complaints.

    À votre santé.

  12. Having a cholesterol test myself tomorrow; no doubt my levels will be as high as the number of fat grams in a Big Mac. I wonder how helpful all these tests are, and what is the ratio between correct and our level of comfort, anyway?

  13. your son’s term paper sounds fascinating but as you say, a topic that is extremely complex. Two issues that I see – lack of public understanding of science means that people are unable to distinguish between truth and fiction. hence why cosmetic companies can get away with so many nonsensical claims. second issue is the confusion between risk and hazard. politicians end up making rules based purely on the hazard with little consideration of what genuine risk there is.

    Sorry, I will get off my soap box now

  14. Having recently been for a prostate check I can relate. Unpleasant (frankly I was traumatised and then felt ashamed about being so weak) and I still haven’t been for the follow-up blood test. But I agree that every few years is the way to go for these things. Poor Mr LL – I do hope the ribs are feeling better. And I’m sure your son came away from the chat with bucketloads of useful insights. Very interesting re Alice Stewart too.

  15. LOL. I have a husband like that. On a more serious note, I really wish someone would create a website where people could easily check the statistical likelihood of things without any media hype, finding out, say, how likely they are to get Ebola, especially if compared to doing something people don’t fear. For instance: how much more likely are you to die in a car accident than to die from Ebola? Your statistic on Pap smears and false positives is one I never knew.

  16. I hope all is well with all this for both of you soon. As for these issues I’m afraid it is all part of politics and esteem within professions and the media so there’s little hope for clarity and honesty soon, if ever!

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