Overdiagnosis poses a significant threat to human health by labeling healthy people as sick and wasting resources on unnecessary care, warns Ray Moynihan, Senior Research Fellow at Bond University in Australia, in a feature published on bmj.com today.
The feature comes as an international conference 'Preventing Overdiagnosis' is announced for Sept. 10-12, 2013, in the United States, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, in partnership with the BMJ, the leading consumer organization Consumer Reports and Bond University, Australia.
The conference is timely, says Moynihan because "as evidence mounts that we're harming the healthy, concern about overdiagnosis is giving way to concerted action on how to prevent it."
"The Dartmouth Institute for Health Policy and Clinical Practice has long been a leader in understanding and communicating the problems of overdiagnosis," say Drs. Steven Woloshin and Lisa Schwartz, professors of medicine at The Dartmouth Institute for Health Policy and Clinical Practice. "We are extremely excited to host this international conference to advance the science and develop concrete proposals to reduce overdiagnosis and its associated harms."
Overdiagnosis occurs when people are diagnosed and treated for conditions that will never cause them harm and there's growing evidence that this occurs for a wide range of conditions.
For example, a large Canadian study finds that almost a third of people diagnosed with asthma may not have the condition; a systematic review suggests up to one in three breast cancers detected through screenings may be overdiagnosed; and some researchers argue osteoporosis treatments may do more harm than good for women at very low risk of future fracture.
Many factors are driving overdiagnosis, including commercial and professional vested interests, legal incentives and cultural issues, say Moynihan and co-authors, Professors Jenny Doust and David Henry. Ever-more sensitive tests are detecting tiny "abnormalities" that will never progress, while widening disease definitions and lowering treatment thresholds mean people at ever lower risks receive permanent medical labels and life-long therapies that will fail to benefit many of them.
Added to this, is the cost of wasted resources that could be better used to prevent and treat genuine illness.
But Moynihan argues that the main problem of overdiagnosis lies in a strong cultural belief in early detection, fed by deep faith in medical technology. "Increasingly we've come to regard simply being 'at risk' of future disease as being a disease in its own right," he says.
"It took many years for doctors to accept that bacteria caused peptic ulcers," says co-author of the BMJ feature, Dr. David Henry, chief executive officer of the Institute for Clinical Evaluative Sciences, and professor in the Department of Medicine at the University of Toronto, Canada. "Likewise, it will be hard for doctors and the public to recognize that the earliest detection of disease is not always in the best interests of patients."
So what can we do about overdiagnosis?
The 2013 conference will provide a forum for learning more, increasing awareness, and developing ways to prevent the problem. At a policy level, there is a clear need for more independent disease definition processes free from financial conflicts of interest, and a change from the incentives that tend to reward overdiagnosis.
A leading global authority on evidence-based practice, Professor Paul Glasziou from Bond University in Australia says: "As a side effect of our improving diagnostic technology, overdiagnosis is a rapidly growing problem; we must take it seriously now or suffer the consequences of overtreatment and rising health care waste."
As Moynihan and colleagues write in their BMJ feature, concern about overdiagnosis in no way precludes awareness that many people miss out on much needed healthcare. On the contrary, resources wasted on unnecessary care can be much better spent treating and preventing genuine illness, not pseudo-disease. "The challenge is to work out which is which, and to produce and disseminate evidence to help us all make more informed decisions about when a diagnosis might do us more harm than good," they conclude.
Fiona Godlee, editor-in-chief of the BMJ, said: "The harm of overdiagnosis to individuals and the cost to health systems is becoming ever clearer. Far less clear is what we should do about it. Next year's conference is an important step towards some evidence based solutions."
Annmarie Christensen | EurekAlert!
One gene closer to regenerative therapy for muscular disorders
01.06.2017 | Cincinnati Children's Hospital Medical Center
The gut microbiota plays a key role in treatment with classic diabetes medication
01.06.2017 | University of Gothenburg
An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.
Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...
Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.
Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...
Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.
As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...
Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.
With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...
Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine
Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...
19.06.2017 | Event News
13.06.2017 | Event News
13.06.2017 | Event News
23.06.2017 | Physics and Astronomy
23.06.2017 | Physics and Astronomy
23.06.2017 | Information Technology