{"id":1789,"date":"2018-08-21T15:17:34","date_gmt":"2018-08-21T15:17:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=1789"},"modified":"2018-09-12T14:36:02","modified_gmt":"2018-09-12T14:36:02","slug":"medicine-more-precise-more-effective-more-overdiagnosis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2018\/08\/21\/medicine-more-precise-more-effective-more-overdiagnosis\/","title":{"rendered":"Medicine: more precise, more effective, more overdiagnosis"},"content":{"rendered":"

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I\u2019m at the 6th preventing overdiagnosis conference chairing a session on Overdiagnosis 2.0 (Technology) by\u00a0 Henrik Vogt<\/a><\/u><\/strong>, <\/strong>Claus Ekstr\u00f8m <\/a><\/u><\/strong>& <\/strong>Johnny Kung<\/a><\/u><\/strong>.\u00a0 So I thought I\u2019d share some insights.<\/p>\n

Carl Heneghan at Preventing Overdiagnosis<\/p>\n

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\"\"Henrik Vogt<\/a><\/u><\/strong>\u00a0from the GP research unit at Trondheim talked about the impact of new technology \u2018that is heavily geared to screening, which will create a new era of overdiagnosis.’\u00a0 Up to now, Henrik argued, that screening has been about using a few biomarkers in select populations. However, in this new era of wearables and smart technology, there will be multiple opportunities to screen largely well individuals, more or less all the time.<\/p>\n

\u2018Big data precision medicines entails a massive, new form of screening (screening 2.0),\u2019 he said.<\/p>\n

Here\u2019s an example form this week\u2019s New York Times:<\/p>\n

\"\"\u2018researchers are now building a website that will allow anyone to upload genetic data from a company like 23andMe or Ancestry.com. Users will receive risk scores for heart disease, breast cancer, Type 2 diabetes, chronic inflammatory bowel disease and atrial fibrillation.\u2019\u00a0 <\/em><\/p>\n

Claus Ekstr\u00f8m,\u00a0<\/a><\/u><\/strong>Professor of Biostatistics at the University of Copenhagen, talked about the \u2018inevitable statistical problem with overdiagnosis and a future that might include, for example, whole genome sequencing in newborns.<\/p>\n

The\u00a0concept of overdiagnosis<\/a>,\u00a0which means making people patients unnecessarily, by identifying problems that were never going to cause harm or by medicalising ordinary life experiences through expanded definitions of diseases will largely be ignored by new methods that capture big data.<\/span><\/p>\n

The false promises of big data will include absurdly accurate results, everything that can be captured will be captured and correlations will tell us all (in the future causality\u00a0will be deemed less important).<\/p>\n

\"\"<\/strong>\u00a0Henrik Voigt<\/strong> pointing out that Jeremy Hunt thinks it’s really important in the NHS we’re ready to harness the power of data to give us more accurate diagnosis.<\/p>\n

Johnny Kung,<\/a><\/u><\/strong>\u00a0of the Personal Genetics Education\u00a0Project at Harvard University that aims to raise awareness\u00a0about the potential benefits as well as the downsides of genetic screening. Take a look at their\u00a0lessons plans here<\/a>).<\/p>\n

Consumer genetic testing is now being marketed for a variety of reasons directly to consumers that include\u00a0carrier testing, ancestry testing, predicting\u00a0sports ability and your IQ amongst others so-called benefits. Watch out for your ‘polygenic score’ for predicting your disease risk and non-invasive prenatal testing (cell-free fetal DNA) as potential new ways of creating overdiagnosis along with ethical and moral issues that need addressing.<\/p>\n

So what did I conclude from the overdiagnosis and new technology 2.0 session? I’m taking away that consumer testing will be the new norm and that there is a heap of understanding and education required to stop the public from wasting their money, and more importantly. causing themselves harm.<\/p>\n

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Overdiagnosis: what it is and what it isn\u2019t<\/cite><\/a><\/header>\n

Brodersen<\/span>\u00a0J<\/span>,\u00a0Schwartz<\/span>\u00a0LM<\/span>,\u00a0Heneghan<\/span>\u00a0C<\/span><\/span>, et al\u00a0<\/span>Overdiagnosis: what it is and what it isn\u2019t\u00a0BMJ Evidence-Based Medicine\u00a0<\/span>2018;<\/span>23:<\/span>1-3.<\/span><\/p>\n