Medicine has avoided facing a harsh reality. Although we assume that
medical decisions are driven by established scientific fact, even a
cursory review of practice patterns shows that they are not. Angioplasty
became a multibillion-dollar industry long before a single randomized
trial or epidemiologic study had shown its benefits [1]. Large numbers
of MRI units were purchased during the first 5 years of their clinical
availability, before any data were available to show that MRI was
preferable to the diagnostic alternatives [2]. Also, although randomized
trials have proved the lifesaving value of mammography only in women
over 50 years of age [3], the American College of Radiology advises that
women begin receiving regular testing at 40 years of age.
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