Overdiagnosis poses significant threat to human health

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 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 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 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."

More information: www.bmj.com/cgi/doi/10.1136/bmj.e3502

Related Stories

New breast cancer screening guidelines released

Nov 21, 2011

New breast cancer screening guidelines for women at average risk of breast cancer, published in CMAJ (Canadian Medical Association Journal), recommend no routine mammography screening for women aged 40-49 and extend the sc ...

Overdiagnosis since introduction of prostate cancer screening

Aug 31, 2009

The introduction of prostate-antigen screening, or PSA, has resulted in over 1 million additional men over the last 23 years being diagnosed and treated for prostate cancer—most of whom were likely overdiagnosed, researchers ...

Recommended for you

Study recommends inmate immunity test

7 hours ago

(AP)—Federal experts are recommending that California test inmates for immunity to a sometimes fatal soil-borne fungus before incarcerating them at two Central Valley state prisons where the disease has killed nearly three ...

Down syndrome teens need support, health assessed

14 hours ago

Young adults with Down syndrome experience a range of physical and mental health conditions over and above those commonly reported in children with the condition—and these health problems may significantly ...

Time out for exercise

14 hours ago

University of Queensland researcher has found that restructuring our daily routine to include exercise can have unexpected effects on health.

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

PeterD
not rated yet May 31, 2012
Over diagnosis and over treatment is all about the money doctors make from doing this. Duh!