The Median Is Not the (Only) Message
Authors: David Casarett
Journal: Annals of Internal Medicine (2006)

Editorials7 November 2006The Median Is Not the (Only) MessageDavid Casarett, MD, MADavid Casarett, MD, MAFrom Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-9-200611070-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When Stephen Jay Gould developed a particularly aggressive form of mesothelioma in 1982, his review of the medical literature led him to conclude—prematurely, as it turned out—that he had only 8 months to live. In a popular article published 3 years later, Gould famously reminded his fellow patients that “the median is not the message” (1), and he argued that median survival is ambiguous at best and is both misleading and discouraging at worst. As increasingly sophisticated predictive models have advanced the science of prognostication, Gould's warning has become even more relevant. In addition, it is a particularly useful background ...References1. Gould SJ. The median is not the message. Discover. 1985;6:40-2. Google Scholar2. Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: implications for screening. Ann Intern Med. 2006;145:646-53. LinkGoogle Scholar3. McCarthy EP, Ngo LH, Roetzheim RG, Chirikos TN, Li D, Drews RE, et al. Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med. 2006;145:637-45. LinkGoogle Scholar4. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285:2750-6. [PMID: 11386931] CrossrefMedlineGoogle Scholar5. Welch HG, Albertsen PC, Nease RF, Bubolz TA, Wasson JH. 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PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDisparities in Breast Cancer Treatment and Survival for Women with Disabilities Ellen P. McCarthy , Long H. Ngo , Richard G. Roetzheim , Thomas N. Chirikos , Donglin Li , Reed E. Drews , and Lisa I. Iezzoni The Effect of Age and Chronic Illness on Life Expectancy after a Diagnosis of Colorectal Cancer: Implications for Screening Cary P. Gross , Gail J. McAvay , Harlan M. Krumholz , A. David Paltiel , Devina Bhasin , and Mary E. 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