Climbing Out of the Trenches: Rethinking Polarisation in Medicine

I met Elspeth Davies at the Preventing Overdiagnosis 2025 International Conference in September, where she gave a terrific talk titled: Beyond polarisation: How do we engage with people who disagree with us? Her talk resonated with me. I often find myself cautioning against overdiagnosis and overtreatment, but sense my arguments are less attractive than those of people pitching early diagnosis followed by potentially life-saving treatment. Dr. Davies articulated the tension in this divide and offered some hope of a way forward.

She recently published a related essay in the BMJ, and I was pleased that she was willing to write this summary for Sensible Medicine.

Adam Cifu

In today’s increasingly pressured health systems—stretched by staffing shortages, rising demand, and a surge of new technologies—the ability to openly evaluate medical interventions has never mattered more. Yet, as I argue in a recent features essay in the BMJ, medicine is plagued by a landscape of entrenched camps and combative debates. The result in some fields is a climate where meaningful engagement between those who disagree has become difficult, and sometimes nearly impossible.

I offer early detection and overdiagnosis, a field so divided that discussions have long been referred to as the “screening wars”, as a case study. Professionals on both sides recount experiences of name-calling and accusations of conspiracy, describing this scientific debate in the language of battlefields and trenches.

What’s Beneath the Disagreement? Ethics as Much as Evidence

I argue that these polarized debates are not simply methodological disagreements about study design or outcome measures—they stem from deeper ethical questions about the role of medicine in a good life.

At the heart of early detection debates lie fundamental questions:

• What counts as disease?
  In symptomatic conditions like depression, this means deciding where normal life ends and pathology begins. In screening, it involves grappling with lesions that may never progress.

• What does it mean to be well?
  Early diagnosis may prevent future harm, but medicalisation can also produce physical side effects, psychological distress, and a long-term “patient identity” that erodes quality of life in the present.

• How do we interpret risk?
  Population-level data, even with sophisticated risk stratification, can never fully capture the uniqueness of individuals. The uncertainty produced by this gap drives much of the tension.

Breast cancer screening illustrates these dilemmas vividly. While screening can save lives, the UK Independent Review found that for every life saved, around three women are overdiagnosed—diagnosed with cancers that would not have progressed. Such findings generate very different ethical responses depending on whether one prioritises preventing mortality or avoiding harm from unnecessary intervention.

Why the “For vs Against” Framing Fails Us

Despite much talk of warzones, there is much that people in even the most heated debates can agree on. Many advocates of screening acknowledge overdiagnosis as a significant issue. And many critics of early detection also recognize its potential benefits.

Yet debates continue to be framed in binary terms: for early detection vs against it; believers vs nihilists; advocates vs sceptics. This framing obscures the much richer spectrum of perspectives that actually exists.

Changing the Terms of the Conversation

In the BMJ essay, I propose several strategies to move beyond polarisation:

1. Shift from battle metaphors to spectrum thinking

   Instead of imagining two opposing camps, we should visualise a continuum: from those who prioritise the benefits of early intervention to those who emphasise avoiding harm. Individuals may occupy different positions depending on the clinical context—prostate screening versus COVID vaccination, for example.

2. Use more precise language

   Terms like “early detection” and “overdiagnosis” carry binary implications and may reinforce division. More specific alternatives—such as “cancers with uncertain likelihood of progression” or the broader concept of “optimal diagnosis”—may foster collaboration by focusing on shared goals rather than ideological labels.

   Similarly, in other fields, labels such as “anti-vaxxer” homogenize diverse groups and prevent constructive dialogue.

3. Prioritise listening, curiosity, and humility

   In these debates, practical listening skills matter, such as:

   • asking open-ended questions

   • summarising others’ views and checking understanding

   • trying to see how someone’s experiences led them to their stance

Such practices help identify the actual points of disagreement and open space for productive engagement.

A Way Forward for Medicine

As opportunities for earlier intervention proliferate and pressures on healthcare systems mount, the medical community must resist slipping deeper into polarisation. Early detection debates offer important lessons for all contentious areas in medicine.

Ultimately, we can choose to keep fighting from our ideological trenches—or we can collectively climb out of them. The path forward lies in recognising shared aims, refining our language, and renewing our commitment to listening across differences.

Elspeth Davies, PhD, is a Senior Researcher in the Nuffield Department of Primary Care Health Sciences, University of Oxford.

Photo Credit: Stephen Pedersen