Guidelines for health are meant to guide, not mandate

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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

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