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Preventing overdiagnosis: how to stop harming the healthy

Evidence is mounting that medicine is harming healthy people through ever earlier detection and ever wider definition of disease, according to an article published in the British Medical Journal (BMJ).

Bond University researchers Ray Moynihan and Professor Jenny Doust co-authored the BMJ article “Preventing overdiagnosis: how to stop harming the healthy”, together with CEO of Canada’s Institute for Clinical Evaluative Sciences Mr David Henry.

The article includes the announcement of an international conference to improve understanding of the problem of overdiagnosis.

Hosted by he Dartmouth Institute for Health Policy and Clinical Practice in partnership with Bond University, the BMJ and the leading US consumer organisation Consumer Reports, the Preventing Overdiagnosis conference will be held in the United States on 10-12 September, 2013.

Moynihan, Doust and Henry say the conference is timely, as growing concern about overdiagnosis is giving way to concerted action.

“Medicine’s much hailed ability to help the sick is fast being challenged by its propensity to harm the healthy,” they said.

“A burgeoning scientific literature is fuelling public concerns that too many people are being overdosed, over-treated, and overdiagnosed.

“Screening programs are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify “abnormalities” so tiny they will remain benign, while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them.

“With estimates that more than $200 bn USD may be wasted on unnecessary treatment every year in the United States alone, the cumulative burden from overdiagnosis poses a significant threat to human health.”

They say the downsides of overdiagnosis include the negative effects of unnecessary labelling, the harms of unneeded tests and therapies, and the opportunity cost of wasted resources that could be better used to treat or prevent genuine illness.

“At the clinical level, a key aim is to better discriminate between benign “abnormalities” and those that will go on to cause harm,” they said.

“In terms of education and raising awareness among both the public and professionals, more honest information is needed about the risk of overdiagnosis, particularly related to screening.”

“Concern about overdiagnosis does not preclude 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.

“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 good than harm,” they said.

About the Authors:

  • Ray Moynihan, Senior Research Fellow, Bond University, Robina, Queensland, Australia;
  • Jenny Doust, Professor of clinical epidemiology, Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Australia;
  • David Henry, Chief executive officer, Institute for Clinical Evaluative Sciences, Toronto, Canada.

For further information on the Preventing Overdiagnosis conference please visit www.preventingoverdiagnosis.net.

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