Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Climate change and cancer screening: Leave causation to the experts

Peter Ubel, MD
Physician
October 9, 2013
Share
Tweet
Share

In the wake of the horrific floods that struck Colorado recently, many people have debated whether global warming is to blame. The same goes for wildfires that hit that state this summer and for the massive tornado that struck in Oklahoma this spring. In the wake of that tornado, for instance, Senator Sheldon Whitehouse from Rhode Island claimed that Republican opposition to climate change legislation was at fault, for trying to “protect the market share of polluters.”  Senator Barbara Boxer was confident about the cause of the terrible twister too: “This is climate change” she said.

The same finger pointing occurred after super storm Sandy, with some people even claiming that global warming could make storms like Sandy into the new normal, occurring as often as every other year, and Governor Chris Christie just as adamantly denying that global warming played any role in this storm.

The problem with these debates is familiar to those of us in the medical community who have followed controversies about breast cancer screening — people mistakenly and all too understandably seek out explanations for individual events when science can only tell us about aggregate truths.  For the same reason we cannot tell whether an individual mammogram saved a woman’s life, we cannot determine whether any specific storm is the result of climate change.  Instead, we are left with what we can learn from statistics.

Wondering why we don’t know whether a specific mammography test saved a woman’s life?  Suppose a routine mammogram reveals a tumor in an otherwise healthy 56-year-old woman.  She is treated with surgery and pills and lives 20 more years before dying of a heart attack.  It may seem obvious that the mammogram saved her life.  But in fact, there is no way to know whether she would have died of breast cancer within that 20 year period if it hadn’t been for that mammogram.  For all we know, her cancer might never have progressed. In fact, experts now realize that some early tumors actually shrink over time, even when left alone.  It is also possible that this woman would have discovered the tumor without a mammogram, and the tumor still would have been susceptible to treatment.

For many of the same reasons, we also have a hard time knowing whether people who die of breast cancer would have avoided that fate had they received more frequent mammograms.  When I took care of patients with advanced cancer — patients who had avoided physicians like me and all of our pesky screening tests — I would find myself bemoaning their avoidable fates: “If they had only come to my clinic sooner, I would have found their cancers before they became incurable.”  But of course, I couldn’t know whether that was true for any individual patient.  Some women die of breast cancer despite receiving annual mammograms, after all.

Pretty unsatisfying huh?  It is natural to seek out causal explanations for good and bad events.  We want to know whether this hurricane and that tornado are caused by climate change, and whether this prostate cancer or that breast cancer could have been prevented by more aggressive screening.  Instead, we are only left with the data, and with scientists telling us how much more or less likely these events would have been if circumstances had been different.

Climate scientists run predictive models to estimate the likelihood of extreme weather events if temperatures rise due to carbon accumulation in the environment.  Most such experts contend that hurricanes will become more common and more dangerous if temperatures continue to rise, but aren’t so sure tornadoes will become more common.  But no respectable climate expert would blame any single hurricane on global warming.  Such an attribution would be horrific science.

By the same token, most medical experts contend that mammography reduces breast cancer deaths.  But no respectable physician would argue that a given mammogram saved a specific woman’s life.

We need to be cautious about claiming we know the specific causes of individual tragedies — whether they involve horrific storms or heart wrenching cancer deaths.  Instead, we should leave speculation about causation up to the experts.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Prev

How do we empower patients with information while not scaring them?

October 9, 2013 Kevin 0
…
Next

Managing chronic headaches in children

October 9, 2013 Kevin 2
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
How do we empower patients with information while not scaring them?
Next Post >
Managing chronic headaches in children

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Physician

  • When a doctor becomes the narrator of a patient’s final chapter

    Ryan McCarthy, MD
  • Gaslighting and professional licensing: a call for reform

    Donald J. Murphy, MD
  • When service doesn’t mean another certification

    Maureen Gibbons, MD
  • Why so many physicians struggle to feel proud—even when they should

    Jessie Mahoney, MD
  • If I had to choose: Choosing the patient over the protocol

    Patrick Hudson, MD
  • How a TV drama exposed the hidden grief of doctors

    Lauren Weintraub, MD
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why physician voices matter in the fight against anti-LGBTQ+ laws

      BJ Ferguson | Policy
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...