Today sees the start of the third annual Preventing Overdiagnosis conference, this year hosted by the National Cancer Institute in Washington DC. The BMJ has been a partner in this event since its inception and it forms an important part of our Too Much Medicine campaign, highlighting the harms to health from medical excess and the waste of valuable resources on unnecessary care.
As part of my pre-conference reading, I’ve taken a trip through The BMJ’s archives and highlighted a small selection of articles on overdiagnosis.
In 2002, The BMJ ran a Too Much Medicine theme issue, calling for action on disease-mongering and the over-medicalisation of normal parts of life such as death, childbirth, and sex. An editorial in that issue by Richard Smith and Ray Moynihan described the pharmaceutical industry’s drive to drum up new business and create not just a pill for every ill, but also “an ill for every pill.” The editorial quoted Ivan Illich, who in 1976 argued that modern medicine was eroding individual and cultural capacity to cope with end of life, pain, and sickness, launching instead an inhuman attempt to “fix” these problems.
Over the years there has continued to be a growing recognition of the downsides associated with expanding disease definitions and advances in diagnostic testing. In The BMJ, the overdiagnosis series of articles explore the impact of these changes. To give you a flavour, here are just some of the questions that these articles investigate: What is the effect of lowering the diagnostic threshold for pre-diabetes? Better detection may have improved our diagnosis of thyroid cancer, but has it improved outcomes for patients? Have lifestyle changes altered the prevalence of abdominal aortic aneurysms and tipped the balance of screening towards harm?
Previous articles have also discussed drivers of overdiagnosis. In a pair of essays, Iona Heath looks at the role of fear and vested interests. Ray Moynihan’s article “Scientists find new disease: motivational deficiency disorder” may be a light hearted illustration of how diseases are created to sell medicines, but sadly this story is seen all too often in real life—most recently in the limelight thanks to the FDA’s decision to approve flibanserin for female sexual dysfunction.
So where now? We continue to map the extent of the problem, while looking for a way forward. In an analysis article published last week, Daniel Morgan and colleagues highlighted the gaps in our understanding of medical overuse and put forward a research agenda.
Engaging the public in these debates is vital. Campaigns such as Choosing Wisely aim to promote conversations between providers and patients, and empower patients to question the necessity of tests and treatments.
Of course, one musn’t forget the problem of undertreatment, and the challenge is to get the balance right. It seems intuitive that freeing up resources otherwise wasted on excessive testing and treatment would go some way to ensure that it is spent on care that is necessary and effective for those that need it the most.
Looking through the Preventing Overdiagnosis conference programme, it’s clear that people are thinking about the causes, effects, and solutions to the problem in new and interesting ways. There are so many fascinating seminars and workshops over the next few days; do follow along on the Twitter hashtag #PODC2015 and add to the discussion.
For more from The BMJ archives on overdiagnosis, see our interactive timeline.
To follow events from Preventing Overdiagnosis 2015 and contribute to the discussion, use the conference hashtag on Twitter #PODC2015.
Navjoyt Ladher is a clinical editor, BMJ.