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Is an indistinct picture “exactly what we need”? Objectivity, accuracy, and harm in imaging for cancer
Author(s) -
Reid Lynette
Publication year - 2018
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12965
Subject(s) - overdiagnosis , harm , objectivity (philosophy) , epistemology , disease , medicine , odds , thyroid cancer , psychology , cancer , pathology , philosophy , social psychology , logistic regression
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.”