Often crammed into a small section of a page, with variable quality of 'expert', and with the available space often given over to more than one question, I would argue that the medical / health columns in magazines are not conducive to provision of nuanced health advice with appropriate caveats.

Recently, the "Doctor Doctor" column in the Guardian Weekend magazine carried a reader's question regarding mammograms.

Having written of the advice given to her and to her sister (one was advised that she "should have an annual mammogram", the other that "annual screening would expose her to more radiation"), the reader had asked "Is it safe for me when we have the same genetic risk?"

Dr Tom Smith told the 41-year old, in response to her query regarding the different advice she and her sister had been given:

My understanding is that an annual x-ray delivers a tiny dose of radiation, equivalent to what you'd receive in a medium-haul flight or two weeks in a high-granite area such as Cornwall or Aberdeen, which don't have higher breast cancer rates than the rest of the country.

On the other hand, waiting three years rather than one for a repeat mammogram triples the time that you might have an undetected early breast cancer. How to balance these two risks is still a matter of argument.

Talk to your specialist about the different attitudes of your clinic and that of your sister, and ask your sister to do the same. You may then get reasons for the difference, though they may not be based on convincing and solid statistical evidence.

Dr Smith's response seems to me to be one that could be characterised as 'OK, as far as it goes'. I think it is sensible to advise the two women* to contact their specialists, and I feel that it is appropriate to attempt to compare the increased exposure to radiation from X-rays with exposure from other sources.

However, there was probably insufficient space to mention everything that may be relevant to readers of the column.

There are several issues around screening women for breast cancer, some women will “get a cancer diagnosis even though their cancer would not have led to death or sickness”, and others will have “higher, but not apparently pathologically elevated, levels of distress and anxiety” due to false positives. Telling people they are ill is not risk-free.

There is also some good discussion of the risks and benefits of mammography in Gerd Gigerenzer's Reckoning With Risk. Gigerenzer writes that: "Before age 50, mammography does not seem to have benefits, only costs. Women at 50, however, face the question of whether the potential benefits outweigh the costs."

However, this is not addressed in the answer given by Dr Tom Smith. The reader has stated that she is 41. While Dr Smith is presumably aware that there is a difference between recommending mammography for a woman with particular risk factors for breast cancer and recommending it for healthy women younger than fifty, his readers may not be.

There is a general danger with medical / health columns that readers may assume that the advice given to the person who has written in will apply equally to them. I would argue that thought should be given as to whether appropriate caveats should be added to such columns when necessary.

While mammography may be appropriate for the reader Dr Smith is addressing, healthy women of the same age as this reader may assume that whether or not they wish to have regular mammograms depends on their view of the balance of risks referred to by Dr Smith.

They may believe that their prefence should be dictated by the risk of undetected breast cancer versus the risk from increased exposure to radiation - and that they need not take into account that mammography in healthy women of their age seems to have no benefits, only risks.

Dr Tom Smith is probably one of the better magazine columnists of this nature. I have attempted to show that even a sensible and well-qualified person such as Dr Smith may find it difficult to produce a medical / health advice column that addresses all that is relevant. Those experts I consider to be less sensible (and/or those who are not as well qualifed as Dr Smith) are probably a bigger problem.

Health / medical columns have also been written by the likes of Michael van Straten (who features in Ben Goldacre's Bad Science), Patrick Holford, Emma Mitchell of the Guardian's Ask Emma column, Stephen Russell (also known as the Barefoot Doctor), and The Observer's John Briffa.

I would imagine that those who have read the columns written by the above-mentioned health experts might agree with my view.

Notes

*I have assumed that the reader who contacted Dr Smith was female. It may be worth pointing out, though, that men do get breast cancer as well. The various figures I've seen indicate that about 1-2% of breast cancer cases are in men.