On January 19, 2022, the McGill University flag was lowered to half-mast in memory of Olli Miettinen (OM), Professor, Faculty of Medicine and Health Sciences.

OM was born in Finland in 1936. His father was a theologian, his mother a teacher. His youth was spent in privation, during the Stalin’s invasion of Finland and World War 2. After the war he served his military obligation and studied first physics and then medicine. After emigration, he obtained a dual PhD in epidemiology and biometrics at the University of Minnesota, then served on the faculty of Harvard University for twenty years, before joining McGill University in Montreal, Canada where he spent the last twenty-five years of his highly productive career. OM has been called ‘the father and grand master of modern epidemiology’.

In a long interview for the journal Epidemiology, James Hanley, guided Dr. Miettinnen through a review of the accomplishments of his career, including more than 200 peer-reviewed articles and numerous textbooks. https://www.youtube.com/watch?v=FYKESrqGnlU

In his opinion, it is key ‘for the teacher to master his field’ and ‘to bring students to the threshold of their own understanding.’

Miettinen disputed majority epidemiological opinions on cancer screening and overdiagnosis.

In the early 1990s, invited to a Cornell University retreat in Snowbird, Utah seeking to find a common thread of research interests for pulmonary medical subspecialties, he advised focus on CT screening (LCS). Over the next 30 years Dr. Miettinen served as an advisor and investigator with Early Lung Cancer Action Program (ELCAP) and later International ELCAP.

In that role, he decried ‘dogmatic epidemiological commitment to randomized control trials’ (RCT).

‘The most straightforward way to study this curability function involves implementation of a screening regimen and follow-up of the detected cases with respect to whether cure was accomplished.’

OM also presented a coherent model to explain how design flaws in LCS RCTs produce a paradox; survival improves, but mortality does not fall comparably, posing the danger of a false-negative study result.

OM’s recommendation against a RCT proved prescient. The IELCAP diagnostic algorithm, he helped to develop, yielded results substantially superior to those in the National Lung Screen Trial (NLST). The evolving IELCAP diagnostic algorithm has been incorporated into all modern LCS screening guidelines.

http://ielcap.org/sites/default/files/I-ELCAP-protocol.pdf

Objectives Historical review of the contributions of Olli Miettinen MD PhD to epidemiology, lung cancer screening and overdiagnosis research.

Method Literature review and analysis.

Results Olli Miettinen who died earlier this year was a contrarian who broke with algorithmic beliefs over benefits and risks of cancer screening, putative overdiagnosis and the paradox of improved survival but no reduction in lung cancer-specific mortality in RCTs.

Conclusions Olli Miettinen was a distinguished Canadian epidemiologist who helped to guide the research activities of the ELCAP and IELCAP research consortiums over a thirty year period. The diagnostic algorithm he strongly influenced has been incorporated into all current lung cancer screening guidelines.