More is Magic


I travel through daily life protected by a veil masking the unforeseen that might befall me and my loved ones. Several years ago, the veil temporarily lifted during a single week in December when I experienced a vision problem in my lone good eye, my wife underwent surgery and my daughter, an avid cyclist, sustained a concussion (yes, she was wearing a helmet) requiring a two day hospitalization.

Unprotected, I longed to prevent and control the occurrence of harmful circumstances for me and my loved ones. Throughout history, humans felt this same desire expressed through incantations, prayer, sacrifices, ritual dances, magic and superstitions to ward off the “evil eye.” In healthcare today, this universal need emerges as magical beliefs that “more is better” and “knowledge is power.”

Examples include:

Knowledge is power; uncertainty can be eliminated. Surely more tests lead to greater certainty

Often, multiple testing generates even more uncertainty through “false positives” (an abnormal result when no abnormality exists) or “false negatives” (a normal result despite an abnormality).

An explanation exists as to why I feel this way.

Sometimes with a medical evaluation, uncertainty reins supreme. The probability of developing conditions such as specific cancers, diabetes and heart disease increases with risk factors related to family history, smoking or obesity. Yet, people may succumb to illness for completely unknown reasons. Additionally, symptoms and suffering may exist that modern medicine cannot explain.

Early detection of problems leads to cures.

Although sometimes true, early detection provides no guarantee of improved prognosis.

Don’t just stand there, do something!

Treatments can be ineffective or produce deleterious side effects eroding the quality of life. “Watchful waiting” may at times remain the best course.

As health care tackles reducing unnecessary services (medical services without obvious benefit and with the potential to do more harm than good) we must begin with compassion toward ourselves, patients and their families who, in an attempt to ward off harm, cling to the deep seated magical illusion that “more is better.”

Please use comments below to discuss how you personally and professionally deal with the longing to prevent the occurrence of harmful events.