Granted, it is the print media, rather than the bubble-headed TV doctors that I railed against a couple of days ago, but even so I had a hard time believing this article in the Washington Post when it was forwarded to me.


Washington Post article
Part 1 and Part 2 of Early Detection of Cancer, by me.

It’s like a distilled version of what I wrote and excellent–dare I say it around here these days?–framing of a complex medical/scientific issue for a lay audience. Remember, as you read this, the term “overdiagnosis,” which I should have discussed. Also remember that I (and the authors of this article) are in no way saying that early diagnosis has gone too far. Rather, the point is that there is a balance that must be struck between decreasing mortality and morbidity from cancer due to early diagnosis and increasing overdiagnosis to the point where no lives are saved but many are subjected to unnecessary testing and surgery that do not help them.


  1. #1 factician
    April 15, 2007

    Hmmm… Did I misunderstand you previously? I thought that the conclusion was that one can’t tell whether or not the increased diagnosis is saving lives. Are you now saying that in fact you can tell that it’s not increasing positive outcomes?

  2. #2 Infophile
    April 15, 2007

    I can’t help but wonder whether this article was actually written by someone who read your blog and decided to frame the subject for their audience. However, looking at the note at the end, one of them was apparently the author of a book called “Should I Be Tested for Cancer? Maybe Not and Here’s Why,” so it’s probably just a coincidence that it got published just now.

  3. #3 steppen wolf
    April 15, 2007


    You are the last one needing framing lessons around here. It shows in your writing. Might that be because, apart from the fact that you are knowledgeable, you actually understood that we frame things (consciously or unconsciously) all the time, depending on who is listening to us/reading our papers/articles/letters of intent? Yeah, that’s my guess – but apparently that is not so obvious to others…

    Thanks for making useful posts,

    steppen wolf

  4. #4 Angrytoxicologist
    April 16, 2007

    Thanks for posting this. We could use all the examples of good medical journalism that we can get. I think that it is most impressive that the article discusses balancing values. This is what many decisions are, yet most stories are written as if there is a clear right and wrong answer to every problem.
    Kudos to you and the WP for letting lay-people in on what the pros and cons really are.

  5. #5 Diora
    April 16, 2007

    Since the authors are the doctors and researchers from Dartmouth and not journalists, I wouldn’t praise media for this one. They did publish it, kudos to them, but they haven’t written it. Infophile, if you search for H Gilbert Welch you can find a number of publications on the subject of screening, so I doubt that the publication is related to this blog. You can also find an interesting rapid response by Welch to the BMJ article about overdiagnosis in Malmo trial in which he points out a problem with authors’ math.

    BTW, in “Should I be tested for cancer? Maybe not and here is why”, Dr Gilbert H Welch argues that the decision to participate in any kind of screening (including recommended testing) is a personal choice that is far from obvious and that “the decision to forgo testing is a reasonable one”. I do recommend the book, by the way, it discusses many of the issues in a language can be easily understood by anyone. Many doctors brought up a question of how to explain benefits/risks of screening without complex statistics – see how it is done in this book.

    Here is by the way is a Dartmouth articls which summarizes many of the opinions of the authors’ of this article.

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