Is an indistinct picture “exactly what we need”? Objectivity, accuracy, and harm in imaging for cancer

Lynette Reid

doi:10.1111/jep.12965

Is an indistinct picture “exactly what we need”? Objectivity, accuracy, and harm in imaging for cancer

Lynette Reid

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

Assumptions about the epistemic ideal of objectivity, closely related to ontological assumptions about the nature of disease as pathophysiological abnormality, lead us into oversimplified ways of thinking about medical imaging. This is illustrated by current controversies in the early detection of cancer. Improvements in the technical quality of imaging failed to address the problem of overdiagnosis in breast cancer screening and exacerbate the problem in thyroid cancer diagnosis. Drawing on Douglas and on Daston and Galison, I distinguish 3 dimensions of objectivity (accuracy, reliability, and precision) and demonstrate ways they may be at odds, as illustrated in the early detection of cancer. Guidelines for evaluating the efficacy of diagnostic imaging are insufficiently sensitive to this complexity. Improving imaging quality may raise epistemic issues, place disease definitions in question, and lead to overall harm or to changes in the distribution of harms and benefits among population subgroups. With a nod to Wittgenstein, I argue that we cannot take for granted that “an indistinct picture” is not “exactly what we need.”.

Original language	English
Pages (from-to)	1055-1064
Number of pages	10
Journal	Journal of Evaluation in Clinical Practice
Volume	24
Issue number	5
DOIs	https://doi.org/10.1111/jep.12965
Publication status	Published - Oct 2018

Bibliographical note

Funding Information:
Thanks to audiences at the Nuffield Department of Primary Health Care Science (Oxford) Too Much Medicine conference (2017); the Center for Professional and Applied Ethics at the University of North Carolina, Charlotte; the Bioethics Department at Dalhousie University; participants in the workshop on ethics and epistemology of early detection hosted by Cambridge University's Department of History and Philosophy of Science (2017); the McGill Biomedical Ethics Unit; and the peer reviewers for this journal for their feedback on earlier drafts. Revisions were completed during a residency at the Fondation Brocher on the topic of overdiagnosis.

Publisher Copyright:
© 2018 John Wiley & Sons, Ltd.

ASJC Scopus Subject Areas

Health Policy
Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/jep.12965

Cite this

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abstract = "Assumptions about the epistemic ideal of objectivity, closely related to ontological assumptions about the nature of disease as pathophysiological abnormality, lead us into oversimplified ways of thinking about medical imaging. This is illustrated by current controversies in the early detection of cancer. Improvements in the technical quality of imaging failed to address the problem of overdiagnosis in breast cancer screening and exacerbate the problem in thyroid cancer diagnosis. Drawing on Douglas and on Daston and Galison, I distinguish 3 dimensions of objectivity (accuracy, reliability, and precision) and demonstrate ways they may be at odds, as illustrated in the early detection of cancer. Guidelines for evaluating the efficacy of diagnostic imaging are insufficiently sensitive to this complexity. Improving imaging quality may raise epistemic issues, place disease definitions in question, and lead to overall harm or to changes in the distribution of harms and benefits among population subgroups. With a nod to Wittgenstein, I argue that we cannot take for granted that “an indistinct picture” is not “exactly what we need.”.",

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Is an indistinct picture “exactly what we need”? Objectivity, accuracy, and harm in imaging for cancer

Abstract

Bibliographical note

ASJC Scopus Subject Areas

UN SDGs

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