May 8, 2012

Giving medical advice is sometimes a matter of perspective

Anthony L. Komaroff, M.D.

DEAR READERS: Since I began this column last September, I've received a lot of mail -- both emails and "snail mail." Mostly it's been health questions. I can't answer them all, but I try to answer as many as I can.

You've also sent comments. Many of you have said you like the column, and I thank you for that. However, I've also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I'm a man.

How does it feel to have a mammogram? In describing a mammogram I said: "For some X-ray views, your breast is compressed briefly between two plastic plates. This is somewhat uncomfortable, and many of my patients tell me these plates feel very cold. But the test should not be painful."

Wrong! Quite a number of you wrote to say that in your experience the breast compression was painful, not just uncomfortable. You said you still were going to get regular mammograms, despite the pain, because they can be life-saving. You just objected to my saying they were not painful.

Indeed, when I read my words to my wife, she replied, "You said that?" So I guess I know where she stands.

My lesson? Be very careful about describing experiences that you haven't had yourself.

In another column, replying to a reader seeking advice for her daughter about tanning salons, I wrote: "But as healthy as a tan may make you look, it's not healthy. In fact, tanning can be downright dangerous. That's why you should talk to your daughter and urge her to stop now." I said regular use of tanning beds raised the risk of skin cancer, including potentially lethal melanoma skin cancers.

(In fact, a new study here at Harvard Medical School was published just after my column. Based on 20 years' experience in 730,000 nurses, it strongly supports the dangers.)

However, I concluded by saying: "If (your daughter) really wants a tanned look, suggest using artificial tanners ... But if prom night is a few days away, and she's still not happy with what she sees in the mirror, a single visit to the tanning salon is not the end of the world."

Another reader, who had lost a member of her family to melanoma, said that it was "completely irresponsible" for me to countenance even a single visit to a tanning salon.

I understand why she would feel that way, and I agree with her that a single visit can be the first step on a slippery slope to regular use, unless parents intervene. But I don't know of any evidence that a single visit to a tanning salon raises the risk of skin cancers.

It's a matter of perspective. Not every behavior that is risky if you do it regularly is risky if you do it only occasionally.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

Distributed by Universal Uclick for UFS.