Overdiagnosis & Radiology : Special Issue in Academic Radiology

In an article in Academic Radiology in a special issue focused on unique problem of over diagnosis Author Dr Saurabh Jha writes, " distinction between false positives and overdiagnosis is important to appreciate to understand why overdiagnosis is controversial. The arbiter of a diagnostic test, that is whether the positive test is a true or false positive, is verification by a truth. The truth is known as the gold standard. Disease can be defined at anatomic pathology which is considered the most indisputable truth."

He further writes, " One accepts that a diagnostic test can yield a false positive, as diagnostic tests are imperfect, and the diagnosis rendered by the test is a provisional assumption. For example, a positive cardiac stress test can either be a true or false positive for obstructive coronary artery disease (CAD)." 

 He elaborates the problem of overdiagnosis by giving an example of angiography in CAD. He says, " The truthfulness of the positive finding on a stress test can be verified at cardiac catheter angiogram, which is considered the gold standard for CAD. However, it is less intuitive that the diagnosis of CAD at catheterization, which defines CAD, can be an overdiagnosis, a false positive of kind. What then arbitrates the gold standard for disease? " 

What arbitrates the arbiter, the speaker of truth?

Link to Special Issue by Academic Radiology