Narrative vs Evidence-Based Medicine—And, Not Or

The week before the US Preventive Services Task Force (USPSTF) released its recommendations against routine prostate screening for healthy men, celebrity patients including Joe Torre and Rudy Giuliani had already lined up to challenge the population-based recommendations. To promote their position that screening for prostate-specific antigen is lifesaving, these individuals relied on a powerful tool: their own personal narratives. However, the experts whose goal is to disseminate and translate population-based evidence will, in the name of science, shun individual stories. This one-sided use of narrative has played out repeatedly, from the USPSTF recommendations on screening mammography to the US Food and Drug Administration (FDA) labeling hearings on bevacizumab for advanced breast cancer.^1- 2 Each time, those who espouse only evidence—without narratives about real people—struggle to control the debate. Typically, they lose.