As you can probably tell I’m frustrated with modern medicine’s apparent immunity to evidence, so I hope you’ll suffer my rant-y, short essay this week.

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“Modern medicine tells its own story, one that always begins with control and ends with rescue.”— Arthur W. Frank, The Wounded Storyteller

Sometimes modern medicine is less a science than a theater of control. The costumes are white coats, the set is fluorescent, and the script always ends the same way: We found it early! [Thunderous applause].

Screening has become the profession’s most enduring ritual—not because it works, but because it reassures us someone is doing something.

The United States Preventive Services Task Force (USPSTF), sadly, was meant to be the sober counterweight to this reflex. A kind of moral accountant for the excesses of enthusiasm, decoding evidence and keeping the leger. But even the accountants have stage fright. Every time they try to close the curtain on a screening program they know doesn’t save lives—mammography (2009), PSA (2011), the next thing—they’re met with an outcry: You’re abandoning prevention, you’re letting people die! So the Task Force doesn’t stop screening. It just revises the choreography. “Shared decision-making” becomes the new applause line.

The evidence, meanwhile, is unforgivingly consistent. Decades of cancer screening trials have failed to show reductions in overall mortality, even when disease-specific deaths appear to drop. I’ve written about it before, and the pattern repeats: The test finds more disease, leads to many (many) more procedures, and creates a screening economy, while shuffling death certificates and never extending life. But medicine, like politics, survives on narratives, not negatives. “Lives saved” is a better story than “statistically similar survival curves.”

Mammography and PSA are the twin fables of this stage production. Both began as simple ideas with irresistible moral appeal—catch it early, save a life—and both ran aground on the same reef: overdiagnosis. But their cultural fates diverged. Breast cancer screening is politically untouchable; prostate screening, quietly disavowed. The difference isn’t in the data, which is virtually identical. It’s in the audience. Breast cancer advocacy built an empire of pink (B+ for mammograms, yay!!!). Prostate cancer never got a ribbon that caught the light (C-, booooo).

What fascinates me isn’t the hypocrisy but the sociology. The public doesn’t want a Bayesian conversation; it wants a moral one. And the Task Force knows this. So it compromises, inching toward truth and never arriving. The language shifts: ‘may be beneficial’, ‘individualize’, ‘consider patient preference’. That phrasing isn’t policy—it’s stage direction. It tells clinicians how to pretend.

Meanwhile, mastectomies and lumpectomies skyrocket, impotence and incontinence metastasize, lives are devastated, and the threat of cancer is dangled. Less than 2% of men die of prostate cancer but nearly ten times that experience a scare with annual screening. For women, 2% die of breast cancer yet almost thirty times as many—over half, i.e. most—will have a mammogram showing ‘possible’ cancer.

Is there another medical endeavor like it? Screening has failed in countless trials with literally millions of participants, never finding a true mortality benefit. Yet researchers, authorities, and doctors contort and distract to convince us otherwise.

The deeper pathology is that prevention is performance art for a culture that can’t tolerate uncertainty. Screening is the illusion of agency, offering a transaction: Submit to the machine, and in return you’ll know—you’ll have certainty. Even if (especially if) it changes nothing. The test itself becomes a kind of civic duty, a badge of virtue. Like recycling, but with shocking co-pays.

What we cannot admit is that our obsession with ‘early detection’ is therefore about emotional containment, not biological rescue. That’s why we don’t ask if screening saves lives in any meaningful sense; instead, we ask if it makes us feel more certain. The answer of course is no. But like all good art, it makes the uncertainty more bearable.

The USPSTF is now the director of a Greek tragedy, “The Oracle of the False Positive,” and they will continue to split recommendations into smaller and smaller moral fractions. And the curtain will never fall, because the audience keeps clapping.

But evidence left the building years ago.

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