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!
Inselspital: Fewer CT scans needed after cerebral bleeding
20.03.2019 | Universitätsspital Bern
Building blocks for new medications: the University of Graz is seeking a technology partner
19.03.2019 | Karl-Franzens-Universität Graz
DESY and MPSD scientists create high-order harmonics from solids with controlled polarization states, taking advantage of both crystal symmetry and attosecond electronic dynamics. The newly demonstrated technique might find intriguing applications in petahertz electronics and for spectroscopic studies of novel quantum materials.
The nonlinear process of high-order harmonic generation (HHG) in gases is one of the cornerstones of attosecond science (an attosecond is a billionth of a...
Nano- and microtechnology are promising candidates not only for medical applications such as drug delivery but also for the creation of little robots or flexible integrated sensors. Scientists from the Max Planck Institute for Polymer Research (MPI-P) have created magnetic microparticles, with a newly developed method, that could pave the way for building micro-motors or guiding drugs in the human body to a target, like a tumor. The preparation of such structures as well as their remote-control can be regulated using magnetic fields and therefore can find application in an array of domains.
The magnetic properties of a material control how this material responds to the presence of a magnetic field. Iron oxide is the main component of rust but also...
Due to the special arrangement of its molecules, a new coating made of corn starch is able to repair small scratches by itself through heat: The cross-linking via ring-shaped molecules makes the material mobile, so that it compensates for the scratches and these disappear again.
Superficial micro-scratches on the car body or on other high-gloss surfaces are harmless, but annoying. Especially in the luxury segment such surfaces are...
The Potsdam Echelle Polarimetric and Spectroscopic Instrument (PEPSI) at the Large Binocular Telescope (LBT) in Arizona released its first image of the surface magnetic field of another star. In a paper in the European journal Astronomy & Astrophysics, the PEPSI team presents a Zeeman- Doppler-Image of the surface of the magnetically active star II Pegasi.
A special technique allows astronomers to resolve the surfaces of faraway stars. Those are otherwise only seen as point sources, even in the largest telescopes...
Researchers at Chalmers University of Technology and the University of Gothenburg, Sweden, have proposed a way to create a completely new source of radiation. Ultra-intense light pulses consist of the motion of a single wave and can be described as a tsunami of light. The strong wave can be used to study interactions between matter and light in a unique way. Their research is now published in the scientific journal Physical Review Letters.
"This source of radiation lets us look at reality through a new angle - it is like twisting a mirror and discovering something completely different," says...
11.03.2019 | Event News
01.03.2019 | Event News
28.02.2019 | Event News
25.03.2019 | Trade Fair News
25.03.2019 | Life Sciences
25.03.2019 | Information Technology