Patients' health threatened by overdiagnosis

In a report published in British Medical Journal (BMJ) Ray Moynihan, Senior Research Fellow at Bond University in Australia, highlights the significant threats that overdiagnosis poses to human health. The report comes after an international conference "Preventing Overdiagnosis" was announced for September, 2013 in the United States. The conference will be hosted by The Dartmouth Institute for Health Policy and Clinical Practice, in partnership with the BMJ, Consumer Reports, and Bond University, Australia. According to Moynihan, the conference is timely because "as evidence mounts that we're harming the healthy, concern about overdiagnosis is giving way to concerted action on how to prevent it." Dr Steven Woloshin and Dr Lisa Schwartz, professors of medicine at The Dartmouth Institute for Health Policy and Clinical Practice, said: "The Dartmouth Institute for Health Policy and Clinical Practice has long been a leader in understanding and communicating the problems of over diagnosis. 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 an individual is diagnosed and treated for a "disease" that will never cause them harm or result in death. Furthermore, there is mounting evidence that several individuals are overdiagnosed and overtreated for a wide range of conditions. For instance, studies have found that nearly 33% of individuals diagnosed with asthma in Canada may not actually have the condition; up to 1 in 3 breast cancers detected by screening may be overdiagnosed; and osteoporosis treatments may cause more harm than good for women at very low risk of future fracture. Moynihan and co-authors, Professor Jenny Doust and Professor David Henry state that commercial and professional vested interests are just a few of the many factors that are driving over diagnosis. The researchers note that tiny "abnormalities" that will never progress are being detected in people by ever-more sensitive tests. In addition, lower treatment thresholds and widening disease definitions means that more individuals are unnecessarily receiving life-long treatments that will fail to benefit the majority of them. According to the researchers, the cost of these unnecessary treatments could be used to prevent and treat people with actual illnesses. The fundamental problem of overdiagnosis lies in a strong cultural belief in early detection, said Moynihan, and this belief is powered by deep faith in medical technology. Moynihan explained: "Increasingly we've come to regard simply being "at risk" of future disease as being a disease in its own right." 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, said: "It took many years for doctors to accept that bacteria caused peptic ulcers. Likewise, it will be hard for doctors and the public to recognize that the earliest detection of disease is not always in the best interest of patients." The 2013 conference' forum will increase awareness, provide study information, and develop strategies for preventing overdiagnoses. There is a clear need at policy level for more independent disease definition processes that have no financial conflicts of interest. The system also needs to change incentives that seem to reward overdiagnosis. Professor Paul Glasziou, a leading global authority on evidence-based practice from Bond University in Australia explained: "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." According to the researchers, concern regarding overdiagnosis in no way precludes awareness that many people will go without much needed healthcare. On the contrary, resources that are wasted on unnecessary care could be used to prevent and treat genuine illness, not pseudo-disease. They conclude: "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." Fiona Godlee, Editor-in-Chief at the BMJ, explained: "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."