Debates: what good are they?

Roger Ladouceur

Debate—definition: 1) Examination of a problem involving animated discussion, sometimes moderated, between people with differing opinions. 2) Indicates that an event has been organized to permit a discussion. 3) Inner conflict.

“Inner conflict”...............! That’s exactly what I feel when I read the debates published in Canadian Family Physician. I first read the argument “Pro” and conclude that the author is right. Then I look at the argument “Con” and cannot do otherwise than agree with this author’s point of view! A month later, I go through the same mental gymnastics in reading their respective rebuttals. In short, debates mix me up and leave me confused.

Take the debate published this month ( page 1429) on whether or not to prescribe β-agonists for chronic obstructive pulmonary disease. Salpeter contends, with supporting evidence, that we should avoid prescribing these medications because they are ineffective and could be harmful. Aaron says the opposite, alleging that the data used by Salpeter to make her case are invalid. She replies that the data he used are no better because the studies from which they came were funded by the pharmaceutical industry, which has a tendency to publish only favourable results.

Who is wrong? Who is right? I don’t know. At the end of the day, all I can do is paraphrase Yvon Deschamps by saying, “Debates: what good are they?”

But on second thought, even if the debates often leave us perplexed, they do have some undeniable merits:

First, they give us a chance to become aware of medical issues on which we might not always be up-to-date.
Second, they provide an opportunity for physicians or other health professionals to raise questions about the decisions made by large associations (eg, Is family medicine a specialty?) and organizations (eg, Are Canadian medications too expensive?), and even to argue, with supporting evidence, against the recommendations put out by expert groups (eg, Should we screen 40- to 49-year-old women for breast cancer? Should we screen for prostate cancer or colorectal cancer? Should we prescribe β-blockers for hypertension?).
They also allow us to see that the same evidence can be interpreted various ways.
And above all, they teach us to be wary of the trap of being certain about things.

Even if the debates often leave me perplexed, I tell myself that, usually, there’s no smoke without fire; if there is controversy, there is surely reason for reflection and caution. I think these debates in some way herald an eventual definitive answer.