Monday, 4 June 2012

Overdiagnosis: providing a solution when there is no problem


I just complain about it; these people are doing something about it. Overdiagnosis occurs when people who are healthy are diagnosed with a disease that will not ultimately harm or kill them. It is associated with over-medicalisation and leads to overtreatment and the associated risk of harm. It is a classic example of our tendency to assume that the more tests and treatments we get, the healthier we become. Often it is the opposite.

The leading medical journals are getting behind the move to highlight this problem to the doctors who are doing the overdiagnosing (BMJ article, JAMA article, Archives of Internal Medicine article). The cause of overdiagnosis may stem from the good intentions of the doctors, but their unskeptical approach to new technology and medicine in general is a big part of the problem. This of course, is related to their overestimation of the benefits gained by many of the treatments that follow the diagnosis, and good examples are discussed in the BMJ article.

We can also blame the easy target: industry, but the public are also partly to blame, and they should accept some of the responsibility to correct the problem; the doctors are in too deep. The public has been led to expect a diagnosis and a cure if they have a complaint, and to be screened for a diagnosis if they feel normal. From the evidence provided on overdiagnosis, patients could benefit from adopting a more inquisitive, sceptical attitude towards medicine.

2 comments:

  1. There's enough blame to go around nicely to a number of culprits: doctors, patients, Big Pharma, and specifically those annoying Direct To Consumer "Ask Your Doctor" ads. You might wonder why the U.S. is one of only two countries on the planet (the other is New Zealand) who still allow these ads. More on this at: "How To Turn a Condition Into a Disease by Selling Sickness" at: http://ethicalnag.org/2011/05/07/big-pharma-selling-sickness/

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  2. Thanks cz,
    I think The Ethical Nag has some good information, and I like the marketing angle it takes. Readers could also click on any link involving Ray Moynihan to get more information on this (see my Like-minded Links for links to both).
    Interestingly, countries without Direct to Consumer marketing (like mine) still have the problems associated with cancer screening and, in my field, with surgeons getting CT and MRI scans on everybody, and then operating on them anyway, just to make sure. Look out for an upcoming post on arthroscopy for more on that.

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