Medical Paradoxes in Clinic, Lab Should Encourage Physicians to Reappraise Ideas about Health and Disease

Sometimes, having choices can be problematic. In his book, The Paradox of Choice: Why More Is Less, psychologist Barry Schwartz, professor of social theory and social action at Swarthmore College in Pennsylvania, takes aim at a central tenet of Western societies—freedom of choice. He argues that more choice can be debilitating and makes us more dissatisfied.¹³ When perusing the multitude of retirement plan options that some employers offer, studies have shown that the more fund options that are offered, the fewer the people who participate. In fact, the highest participation rates are among those employees who are automatically enrolled in their company’s standard plan unless they actively choose not to.¹⁴ The rheumatology analogy to this conundrum is when our patients become anxious when offered to choose among the many biological therapies. With over a dozen offerings on the market and more in development, the freedom of choice can be paralyzing.

Still, I doubt that any of us would ever want to return to the days when the only choices we could offer patients were two formulations of gold salts and a handful of harmful non-steroidal anti-inflammatory drugs. To quote Dr. Emile Duclaux, a physician disciple of Dr. Louis Pasteur: “It is because science is sure of nothing that it is always advancing.”¹⁵ Vive le paradoxe!

Simon M. Helfgott, MD, is associate professor of medicine in the Division of Rheumatology, Immunology and Allergy at Harvard Medical School in Boston.

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