Guidelines for health are meant to guide, not mandate
A good doctor can weigh the risk/benefits of any drug including aspirin much better than a guideline can
{{#rendered}} {{/rendered}}When the U.S. Preventive Services Task Force came out last week against the routine use of aspirin as a preventive in people over 60, citing the risk of bleeding, it did not change my clinical decision-making one iota, and instead reminded me of a basic truth in medicine, patients must be seen and treated as individuals, guidelines are intended to guide, and are not meant to be converted to mandates or dictums.
Don’t get me wrong, a smart clinician should be mindful of a bleeding risk whenever recommending aspirin, and this risk certainly increases with age, but so does the risk that you are building up sticky plaque that could lead to a sudden heart attack or stroke, and a good doctor can weigh the risk/benefits of any drug including aspirin much better than a guideline can.
This brings to mind another time the USPSTF tried to alter the practice of clinical medicine with a superimposed guideline, when they discouraged the routine use of the Prostate Specific Antigen in man over the age of 70, despite the fact that the PSA had led to the earlier diagnosis of prostate cancer leading to more surgical cures.
{{#rendered}} {{/rendered}}Still, this august group pointed to the knee-jerk biopsies and surgeries that frequently resulted from an elevated PSA, which did not prolong life. Whereas I and many urologists and primary care physicians disagreed, arguing that the PSA was a useful tool, and the information it gave you valuable. It wasn’t a PSA that ordered a biopsy, it was a clinician.
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To this day I routinely check the PSA on many men over the age of 45, and I act on the result based on many factors including genetics. No good doctor knee jerks anything.
{{#rendered}} {{/rendered}}The guideline problem has gotten worse during the COVID pandemic, when lockdowns, closures, vaccine and mask mandates have followed straight from guidelines.
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The public has now lost the sense of guidelines guiding physicians, and is reacting negatively instead to the new normal of guidelines leading directly to mandates. The politicization of guidelines is not good for public health whether it applies to vaccine mandates without a carve out for natural immunity or testing negative the way Israel and the European Union has had, or to costly school closures, or to mask mandates without attention paid to what type of mask, whether they are effective or not, and whether taking them off to eat or drink erodes the essential public health strategy.
{{#rendered}} {{/rendered}}This lack of public health consistency was born out by Florida federal court judge Kathryn Kimball Mizelle’s ruling against the CDC’s transportation mask mandate on planes, trains, and busses, based on a disagreement over the term "sanitation" as well as the fact that the CDC didn’t call for a public referendum prior to instituting the rule. This court action has opened a Pandora's box that will likely end in the Supreme Court and could hamper or restrict CDC’s powers.
Population studies have indicated an apparent effectiveness for proper mask use in areas of high viral spread but because of the heavy hand of mandates, as soon as they are lifted there is scarcely a mask in sight.
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{{#rendered}} {{/rendered}}This type of on again, off again or red light/green light is hardly consistent with good public health policy. I may choose to continue to fly with an N95 mask, but now I am practically the only one at the airport or on the plane wearing one.
We need to return to an era where guidelines simply guide, and do not mandate, while at the same time, the digital age can be utilized to help inform these guidelines with up to date information. The key to successful public health is flexibility, not dogma.