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Steven Hatch

Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine Hardcover – Illustrated, February 23, 2016

by Steven Hatch (Author)

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There's a running joke among radiologists: finding a tumor in a mammogram is akin to finding a snowball in a blizzard. A bit of medical gallows humor, this simile illustrates the difficulties of finding signals (the snowball) against a background of noise (the blizzard). Doctors are faced with similar difficulties every day when sifting through piles of data from blood tests to X-rays to endless lists of patient symptoms.

Diagnoses are often just educated guesses, and prognoses less certain still. There is a significant amount of uncertainty in the daily practice of medicine, resulting in confusion and potentially deadly complications. Dr. Steven Hatch argues that instead of ignoring this uncertainty, we should embrace it. By digging deeply into a number of rancorous controversies, from breast cancer screening to blood pressure management, Hatch shows us how medicine can fail-sometimes spectacularly-when patients and doctors alike place too much faith in modern medical technology. The key to good health might lie in the ability to recognize the hype created by so many medical reports, sense when to push a physician for more testing, or resist a physician's enthusiasm when unnecessary tests or treatments are being offered.

Both humbling and empowering, Snowball in a Blizzard lays bare the inescapable murkiness that permeates the theory and practice of modern medicine. Essential reading for physicians and patients alike, this book shows how, by recognizing rather than denying that uncertainty, we can all make better health decisions.

Print length

312 pages
Language

English
Publisher

Basic Books
Publication date

February 23, 2016
Dimensions

6.5 x 1 x 9.5 inches
ISBN-10

0465050646
ISBN-13

978-0465050642
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Editorial Reviews

Review

"Uncertainty lies at the heart of modern medicine in ways that most physicians--not to mention their patients--often fail to recognize. Fundamental imperfections in our understanding of health and disease limit doctors' ability to combat illness. Hatch, an assistant professor of medicine at the University of Massachusetts Medical School, argues that physicians who ignore this uncertainty often overtreat their patients, resulting in sometimes harmful, even fatal consequences. By the same token, far too many patients assume that more medical care is always better than less, thereby seeking or consenting to toxic treatments that trigger needless suffering. Hatch provides examples from such fields as breast cancer, cardiology and infectious disease. He also offers straightforward rules of thumb to help readers navigate medical advice."―Scientific American

"Informative...Snowball in a Blizzard adds an important perspective...[The book] rightly sounds the alarm: Better communication between doctors and patients is essential to improve medical decision making."―Wall Street Journal

"A penetrating examination of uncertainty in diagnoses and treatment."―Nature

"Snowball in a Blizzard is Hatch's first book, but the clarity and wit of his discussions rank with that of the best science writers."―Shelf Awareness

"This intriguing perspective on the obscurity of medicine...is highly recommended for health-care professionals, health-conscious patients, and well-informed consumer health readers."―Library Journal, starred review

"A carefully argued, unsettling, and important work."―Publishers Weekly

"In writing, Hatch strives to find 'that sweet spot where readability and scholarliness overlap'... 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... Hatch ably reveals the shortcomings of medicine."―Kirkus Reviews

"I can say with certainty that Steven Hatch's Snowball astutely deconstructs the uncertainty in the practice of medicine--from diagnosis to treatment to media coverage--as well as this important topic has ever been tackled."―Eric Topol, author of The Patient Will See You Now

"What could be more intuitive: that physicians should be humble, admitting the uncertainty of their medical sciences and treating their patients like equals. Would that it were. Although who knows--if enough doctors and patients read Steve Hatch's masterfully-argued Snowball--maybe someday it will be."―Larry Tye, Director of the Boston-based Health Coverage Fellowship and author of New York Times bestseller Satchel

"Hatch's Snowball in a Blizzard is like Carl Sagan's famous 'baloney detection kit' for medical scientific research. How can we figure out which 'discoveries' to trust or to take with a grain of salt? First step: Read this book."―Katrina Firlik, MD, Author of Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside

About the Author

Steven Hatch is an assistant professor of medicine at the University of Massachusetts Medical School, working in the Division of Infectious Disease and Immunology. He lives in Newton, Massachusetts.

Product details

Publisher ‏ : ‎ Basic Books; 1st edition (February 23, 2016)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 312 pages
ISBN-10 ‏ : ‎ 0465050646
ISBN-13 ‏ : ‎ 978-0465050642
Item Weight ‏ : ‎ 1.1 pounds
Dimensions ‏ : ‎ 6.5 x 1 x 9.5 inches

Best Sellers Rank: #1,618,882 in Books (See Top 100 in Books)
- #314 in Medical Management & Reimbursement
- #865 in Health Policy (Books)
- #922 in Medical Diagnosis (Books)

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4.4 out of 5

44 global ratings

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IN8

Certainly Uncertain

Reviewed in the United States 🇺🇸 on March 12, 2016

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Medicine has protected itself, its providers and its recipients from uncertainty and yet we know so little about health and illness, aetiology, diagnosis, treatment and prognosis. We have blurred the lines between normal and abnormal, and medicalised where we don't know whether we should or should not. While this is perhaps hard to accept, given our diet of fads and fantasies, our short term memory and even shorter term attention span, it's certainly the case. The risk however is when we finally set a certainty point that it's an ever moving point. While I like this book, a lot, at times it falls for the very dynamic it seeks to unveil, trying to soothe us with moments of certainty. For instance - yes, vaccines are without a doubt one of medicine's current strongest certainties - but what might tomorrow bring? Is it the same for all vaccines? Will we one day have something more reliable than statistics on which to judge certainty? I think an open mind to uncertainty to the end of the book would have done the topic more justice.

8 people found this helpful

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Isaac P Hazard

Great food for thought

Reviewed in the United States 🇺🇸 on March 6, 2016

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Great book! Dr. Hatch illustrates the importance of understanding the level of uncertainty that health care professionals (and patients) face daily. While the content relates specifically to medicine, the lessons can be extrapolated to our approach to the rest of the sciences and even to life in general. In today's world, both professional and lay person alike are bombarded with information. As humans we are predisposed to fit that information into a category of true/untrue. While this mode of thinking has many advantages (speed, simplicity) it also leads to placing too much confidence in some information and not in others which can in turn lead to bad choices.

More and more we live in a society that deifies the role of the expert. When faced with a question outside of our own particular milieu, we place near 100% faith in the recommendations of one or more selected experts without appreciating the level to which that expert is or should be confident in that recommendation. In this book, Dr. Hatch helps us to identify when this type of mistake is likely to happen and provides us with a framework (the 'spectrum of uncertainty') to place this information in a more rational context. Let's hope we listen.

13 people found this helpful

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DDNS

Such an important book, so well written!

Reviewed in the United States 🇺🇸 on November 5, 2016

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Get two copies: after you finish reading one, you'll want to give the other to your physician.

Written with passion, humor, and Dawkins-class clarity, "Snowball in a blizzard" is as pleasurable to read as it is instrumental to the understanding of a central topic in every person's life. It is loaded with real world examples drawn from Hatch's experience as a physician and as a person, as well as the thorough research he has done for this book.

Hatch considers multiple perspectives - of patients, research doctors, practicing physicians, the media, policy makers - and while the picture he paints is sometimes grim, his message is ultimately optimistic and empowering.

If you liked Siddhartha Mukherjee's Emperor of All Maladies, I think you're going to enjoy Snowball in a blizzard. (OK, even if you didn't).

This is without doubt one of the best books I've read in a long time!

2 people found this helpful

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SidP

A courageous look and discussion about medical treatment

Reviewed in the United States 🇺🇸 on December 7, 2016

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This is a person who has both intellect and experience. He provides insight and humor while educating. A worthwhile read for medical and scientific professionals as well as anyone ("lay-persons") who are interested in learning about the process of diagnosis and how doctors make their conclusions. As someone who has had to think for himself about how treatments should be decided, I wish I could have read this book years ago as it would have encouraged me and bolstered my resolve to realize medical professionals are just human and not always blessed with being correct about diagnoses, prognoses, or recommendations. There's still a lot to learn and understand.

One person found this helpful

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Amazon Customer

Good information. Interesting and helpful for managing your own ...

Reviewed in the United States 🇺🇸 on June 1, 2018

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Good information. Interesting and helpful for managing your own healthcare decision. Gives readers a more realistic expectation of what you can expect from health care professionals.

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loslofutura

Media clearly needs to do better in reporting medical information.

Reviewed in the United States 🇺🇸 on September 22, 2016

Verified Purchase

It is critical that we understand medicine as informed art as well as science. Steven Hatch shows us why this is so, and also provides a simple template for media to follow to help lay readers understand the reliability of information, based on source, and method as well as what is not known.

One person found this helpful

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Data Scientist

A brilliant book which every person should read

Reviewed in the United States 🇺🇸 on September 10, 2017

Verified Purchase

Brilliant book about why statistics matter for us, when it comes to medicine. I would urge everyone to read this book and understand why over-testing is not helpful, and why a positive reply to your tests doesn't always mean the worst.

Reviewed in the United States 🇺🇸 on June 26, 2019

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I really enjoyed this book - and have quoted it often. Very insightful and well-written, even entertaining.

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Rana

An absolutely wonderful book which goes into the uncertainty surrounding the practice ...

Reviewed in India 🇮🇳 on June 2, 2017

Verified Purchase

An absolutely wonderful book which goes into the uncertainty surrounding the practice of modern medicine. We live in the era of Evidence Based Medicine (EBM). The question this book raises (and tries to answer) is whether the evidence behind EBM is always reliable. This is a must read for all practicing physicians but laypeople who are interested in how medicine works should also read this.

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