SNOWBALL IN A BLIZZARD

An exploration of the uncertainty that lies at the heart of Western medicine.

Hatch (Medicine/Univ. of Massachusetts Medical School), an infectious disease specialist, seeks to help patients understand the consequences of this uncertainty. He presents a spectrum of uncertainty, ranging from strong evidence supporting a high confidence of benefit through pure speculation all the way to strong evidence supporting a high confidence of harm. His focus is the middle of the spectrum, the known unknowns, where much of medicine functions. The opening chapters deal with uncertainty in diagnosis, which takes the author into a discussion of the debate over screening for prostate cancers and breast cancers—reading a mammogram can be as tricky as looking for a snowball in a blizzard. In the next section, Hatch considers uncertainty in treatment, including controversies over how to treat hypertension and Lyme disease. The author also examines uncertainty in drug trials, how the media deal with uncertainty in their reporting, and how patients can best use their knowledge of these uncertainties. In writing, Hatch strives to find “that sweet spot where readability and scholarliness overlap.” Generally, he succeeds, telling stories that clarify the points he’s making, and he even includes a highly personal anecdote that shows him struggling to deal with doctors who were sure they knew the right treatment for his elderly, hospitalized father. The illustrations, however, often seem to have been lifted straight from academic papers and add little to the text. A challenging appendix on the concept of statistical significance provides more information on the subject for curious readers. For doctors, Hatch’s message is that it is acceptable to say, “I don’t know.” For patients, he suggests asking lots of questions and remembering that your doctor should be your guide, not your director.

Hatch ably reveals the shortcomings of medicine but is less successful in providing guidance for those trying to find their ways through the confusion.