From conflict to connection: Challenging polarisation in medical debates

Health systems today face unprecedented strain: workforce shortages, escalating demand, and an accelerating pipeline of new technologies. Against this backdrop, the ability to thoroughly scrutinise the value of medical interventions is essential. Yet, as I discuss in a recent BMJ features essay and a conference keynote, many areas of medicine have become defined by entrenched camps and adversarial debate. In some fields, the atmosphere is so charged that meaningful engagement across differing viewpoints may be almost impossible.

Disagreements regarding early detection and overdiagnosis provide a clear example. This field is so sharply divided that its debates have been described for years as the “screening wars.” Clinicians and researchers on both sides recount instances of personal attack, accusations of vested interests, and rhetoric more akin to military conflict than scientific discourse.

What Lies Beneath the Disagreement? Ethical Questions as Well as Evidence

These tensions cannot be understood purely as disputes over study design or metrics. At their core, they reflect divergent ethical assumptions about the purpose of medicine and what it means to live well.

Several questions recur across these debates:

• What counts as disease?
Whether in mental health or cancer screening, we grapple with where normal experience ends and pathology begins, or whether a localised lesion (unlikely ever to progress) should be called a disease at all.

• What does it mean to be well?
While early diagnosis may prevent morbidity and premature mortality, medicalisation can also bring harm: treatment side effects, psychological burden, and a lasting patient identity that shapes how individuals understand their bodies and futures.

• How should we interpret risk?
Even sophisticated risk stratification cannot eliminate the gap between population-level evidence and the individuality of particular bodies. The uncertainty generated within this gap fuels much of the disagreement.

Breast cancer screening exemplifies these dilemmas. The UK Independent Review found that, for every life saved, approximately three women are overdiagnosed (diagnosed with cancers that would not have progressed). For some, this ratio is unacceptable; for others, it is an unavoidable consequence of saving lives. Both positions are grounded in ethical reasoning as much as scientific interpretation.

Why the “For vs Against” Framing Misleads Us

Despite the warlike rhetoric, there is often substantial common ground. Many proponents of screening acknowledge the harms of overdiagnosis, while many critics of early detection recognise the benefits such interventions can provide.

Yet, despite this, debate sometimes crystallises into opposing camps, leading us to form separate conferences and different professional networks. Discourse tends to be framed in binary terms: for or against early detection, believers versus nihilists, advocates versus sceptics. This may flatten the range of views held by clinicians, researchers, and patients, and obscure the complexity of the underlying issues.

Changing How We Talk - and How We Listen

In my essay, I propose several approaches to help move discussions beyond polarisation.

1. Replace battle metaphors with spectrum thinking
Rather than picturing two opposing sides, it is more accurate - and more productive - to imagine a continuum. People may prioritise early intervention in one context and non-intervention in another. Our values shift with clinical, personal, and societal circumstances.

2. Choose more precise and less polarising language
The terms “early detection” and “overdiagnosis” can imply binary categories that do not reflect clinical reality. Descriptors such as “cancers with uncertain likelihood of progression,” or the broader ambition of achieving “optimal diagnosis,” foreground shared goals rather than entrenched differences.

3. Foster listening, curiosity, and humility
Practical communication techniques can make a genuine difference:
• posing open-ended questions
• summarising someone’s position and checking understanding
• considering how lived experiences shape a person’s stance

These practices help identify the underlying points of disagreement and open the possibility for constructive dialogue.

A Path Forward

As increasingly earlier interventions become possible, and as health services face continuing pressures, medicine cannot afford deeper polarisation. We can continue to defend our positions from within entrenched trenches, or we can make a deliberate effort to step out of them. By recognising shared commitments, refining our language, and approaching disagreement with genuine curiosity, we can foster a more productive and compassionate medical discourse.

Image of Dr Elspeth Davies giving a keynote talk at the Preventing Overdiagnosis Conference, which took place in Oxford’s Examination Schools in September 2025.