Growing evidence and concern about the problem of too much medicine
Influential groups of Australian clinicians, consumers and policy makers have today launched a call to action to address the problems of overdiagnosis and related overtreatment.
Today’s launch follows a National Summit on Overdiagnosis, hosted last month by the Wiser Healthcare research collaboration at the University of Sydney, and attended by almost 60 representatives of leading stakeholders and researchers.
Overdiagnosis happens when people are diagnosed with conditions that would not harm them, leading to unnecessary treatments that can cause more harm than good. One example is thyroid cancer, with evidence many people are diagnosed and treated unnecessarily for very small tumours that are in fact benign.
The statement was developed over the past 12 months – but publicly released for the first time today: “Alongside the undisputed ability of healthcare to extend human life and ameliorate suffering” says the statement, “there is growing evidence and concern about the problem of too much medicine.”
“Overdiagnosis and the related overuse of medical tests and treatments not only causes harm, but also divert resources from addressing underdiagnosis and undertreatment.”
Development of the statement – printed in full below – was facilitated by the NHMRC-funded Wiser Healthcare research collaboration and has been initially endorsed by five leading health organisations including the Consumers Health Forum (CHF), The Royal Australasian College of Physicians (RACP), the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Commission on Safety and Quality in Healthcare (ACSQHC).
"This is the first coordinated national effort to address a problem now recognised worldwide as a significant threat to healthcare,” says Professor Kirsten McCaffery, from University of Sydney, and a member of the Wiser Healthcare team.
The statement released today notes that a key driver of the problem of overdiagnosis is expanding disease definitions and lowering diagnostic thresholds which label more previously healthy people as sick. A series in the leading medical journal The British Medical Journal has raised concerns about this problem across a range of conditions including pulmonary embolism, attention deficit hyperactivity disorder, chronic kidney disease, depression, high blood pressure and osteoporosis.
Another driver is the increasing sophistication of imaging tests that pick up abnormalities that are just as common in people with and without symptoms, but may be mistakenly interpreted as something that needs to be treated, for example in people with back pain.
The Australian plan echoes action in other nations, arising from growing scientific evidence of the problem shared at the international Preventing Overdiagnosis conferences being held in Quebec City this week.
“The problem of too much medicine is driven by many factors – including the best of intentions” says Dr Ray Moynihan, from Bond University and a member of the Wiser Healthcare collaboration.
“But there is now a growing global consensus to start addressing the problem of too many unneeded tests, treatments and diagnoses, which not only threaten human health, but also health system sustainability.”
Initial Statement to underpin the development of a National Action Plan to Prevent Overdiagnosis and Overtreatment in Australia
Statement Endorsed by foundation organisations: CHF, RACP, RACGP, RANZCR, ACSQHC
Alongside the undisputed ability of healthcare to extend human life and ameliorate suffering, there is growing evidence and concern about the problem of too much medicine. Overdiagnosis and the related overuse of medical tests and treatments not only causes harm, but also divert resources from addressing underdiagnosis and undertreatment
There is need in Australia to identify the causes of too much medicine, the extent of the problem, and to develop responses to address it
There is an urgent need to better inform consumers, clinicians, decision-makers and the public about the evidence for, and the consequences of, overdiagnosis and related overtreatment, as part of a broader approach to inform people about the potential harms, as well as the benefits of medical tests and treatments
Expanding disease definitions and lowering diagnostic thresholds are recognised as one driver of the problem, and the processes for changing definitions require meaningful reform
We are committed to evaluation, to ensure that attempts to address too much medicine are both safe and fair for healthcare consumers and their families, and in turn help to optimise the Australian health system’s safety, efficiency and equity of access.
wiserhealthcare.org is an NHMRC collaboration involving leading researchers from University of Sydney, Monash University, Cabrini Institute, and Bond University.