Snowball in a Blizzard: A Physician’s Notes on Uncertainty in Medicine

In this carefully argued, unsettling, and important work, Hatch, assistant professor of medicine at the University of Massachusetts Medical School, analyzes how doctors deal with diagnostic ambiguity. Early detection should save lives, yet, unnervingly, as diagnostic tests detect more early disease, death rates haven’t declined. Hatch explains sophisticated technology (ultrasound, the PSA blood test, CT scans) that turn up subtle abnormalities, and why interpreting a mammogram, for instance, is difficult. He discusses the aftermath of a 2009 decision by the U.S. Preventative Services Task Force, which concluded that yearly mammograms are often not lifesaving and are sometimes harmful. They recommended that women between the ages of 50 and 74 have one biennially, though older and younger women could skip it. Their recommendation was unanimous, but so was the outrage from both doctors and women who have ignored it, despite subsequent studies that confirm its validity. Using simple math, illustrations, and vivid anecdotes, Hatch explains that “positive” tests may be vague, and that people yearn for treatments to succeed so much that they tend to ignore evidence that casts doubt. Hatch’s book may prove to be a tough sell because its conclusions contradict human impulses, but it is worthwhile reading for both doctors and patients. Agent: Andy Ross, Andy Ross Literary Agency. (Feb.)