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      Against conventional wisdom: when the public, the media, and medical practice collide

      research-article
      1 , , 1 , 1 , 1
      BMC Medical Informatics and Decision Making
      BioMed Central
      Articles from the Eisenberg Center Conference Series 2012: Supporting informed decision making when clinical evidence and conventional wisdom collide
      1392012

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          Abstract

          Background

          In 2009, the U.S. Preventive Services Task Force released new mammography screening guidelines that sparked a torrent of criticism. The subsequent conflict was significant and pitted the Task Force against other health organizations, advocacy groups, the media, and the public at large. We argue that this controversy was driven by the systematic removal of uncertainty from science communication. To increase comprehension and adherence, health information communicators remove caveats, limitations, and hedging so science appears simple and more certain. This streamlining process is, in many instances, initiated by researchers as they engage in dissemination of their findings, and it is facilitated by public relations professionals, journalists, public health practitioners, and others whose tasks involve using the results from research for specific purposes.

          Analysis

          Uncertainty is removed from public communication because many communicators believe that it is difficult for people to process and/or that it is something the audience wants to avoid. Uncertainty management theory posits that people can find meaning and value in uncertainty. We define key terms relevant to uncertainty management, describe research on the processing of uncertainty, identify directions for future research, and offer recommendations for scientists, practitioners, and media professionals confronted with uncertain findings.

          Conclusions

          Science is routinely simplified as it is prepared for public consumption. In line with the model of information overload, this practice may increase short-term adherence to recommendations at the expense of long-term message consistency and trust in science.

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          Most cited references26

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          SOME EXPLORATIONS IN INITIAL INTERACTION AND BEYOND: TOWARD A DEVELOPMENTAL THEORY OF INTERPERSONAL COMMUNICATION

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            Communication and Uncertainty Management

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              Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms.

              Despite trials of mammography and widespread use, optimal screening policy is controversial. To evaluate U.S. breast cancer screening strategies. 6 models using common data elements. National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects. A contemporary population cohort. Lifetime. Societal. 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. Varying test sensitivity or treatment patterns did not change conclusions. Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment. Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. National Cancer Institute.
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                Author and article information

                Contributors
                Conference
                BMC Med Inform Decis Mak
                BMC Med Inform Decis Mak
                BMC Medical Informatics and Decision Making
                BioMed Central
                1472-6947
                2013
                6 December 2013
                : 13
                : Suppl 3
                : S4
                Affiliations
                [1 ]Department of Communication, University of Utah, Salt Lake City, UT – 84112, USA
                Article
                1472-6947-13-S3-S4
                10.1186/1472-6947-13-S3-S4
                4029795
                24565173
                9aabd9ea-7353-497c-aa2b-15d0b1701455
                Copyright © 2013 Jensen et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Articles from the Eisenberg Center Conference Series 2012: Supporting informed decision making when clinical evidence and conventional wisdom collide
                Rockville, MD, USA
                1392012
                History
                Categories
                Proceedings

                Bioinformatics & Computational biology
                Bioinformatics & Computational biology

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