I confess that I don't recall having read Ralph Waldo Emerson's essay "Self-Reliance," which contains the quotation: "A foolish consistency is the hobgoblin of little minds, adored by little statesmen and philosophers and divines." Instead, this sentence permanently etched itself into my mind after watching the 1998 romantic comedy "Next Stop Wonderland," which remains my favorite movie set in Boston. And it feels more applicable today than ever, as health officials from Dr. Anthony Fauci to Surgeon General Jerome Adams have been unfairly pilloried for changing their early positions on the threat that COVID-19 posed to Americans and the need to wear face coverings in public. In both cases, compelling new data convinced them to change their minds; rather than adhering to "a foolish consistency," they adapted their public statements to reflect current scientific understanding of the virus and how it is transmitted from person to person.
In the past week, I've done a couple of about-faces on major medical topics in the face of new evidence. A panel for which I represented the American Academy of Family Physicians published a clinical practice guideline that recommends topical non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy for adults with acute pain from musculoskeletal injuries (strains, sprains, and nonoperative fractures) not involving the low back. (A previous guideline covered what to do for patients with acute or chronic low back pain.) I was surprised when the systematic review and meta-analysis we commissioned for this guideline showed that topical NSAIDs were as effective as oral NSAIDs for acute pain; I previously had only prescribed topical NSAIDs for patients with chronic osteoarthritis. In February, in approving the the first topical NSAID for over-the-counter use, the U.S. Food and Drug Administration actually stated that it "is not for immediate relief" and "has not been shown to work for strains, sprains, bruises or sports injuries." That was a true statement at the time, but our understanding of the science has evolved since then. Although cost will be an obstacle for some patients - topical NSAIDs are substantially more expensive than oral NSAIDs - there is now good evidence to prefer the topical versions, which have fewer adverse effects, for acute musculoskeletal pain when feasible.
On a different subject, I announced in a Medscape commentary that "I've Changed My Mind on Lung Cancer Screening." I acknowledge that I am the same Dr. Kenny Lin who nearly a decade ago posted "4 Reasons Not to Be Screened for Lung Cancer" on my now-defunct U.S. News and World Report "Healthcare Headaches" blog. I don't disavow what I wrote previously; it's still important to consider the potential harms I mentioned in 2011 in any conversation with a patient eligible for lung cancer screening (according to the USPSTF's 2020 draft recommendations, adults age 50 to 80 years in good health who have at least a 20 pack-year smoking history and currently smoke or have quit in the past 15 years), and some patients may choose not to be screened, just as some patients decline mammograms or screening tests for colorectal cancer. Given the current evidence that overall benefits of lung cancer screening outweigh the harms, I will recommend this screening test to my patients at the same time I urge them to quit smoking.