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Editorials |

The Median Is Not the (Only) Message

David Casarett, MD, MA
[+] Article, Author, and Disclosure Information

From Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: David Casarett, MD, MA, Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104; e-mail, casarett@mail.med.upenn.edu.

Ann Intern Med. 2006;145(9):700-701. doi:10.7326/0003-4819-145-9-200611070-00014
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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 to 2 important articles in this issue (23).

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