Receiving a diagnosis of a dreaded disease is surely one of the saddest things that can ever happen to us. But what if some of those diagnoses were unnecessary?
Growing evidence suggests doctors are diagnosing many diseases far too frequently, and this problem of "over-diagnosis" is leading to much overtreatment – even threatening the sustainability of our health system.
![Evidence suggests over-diagnosis is leading to much overtreatment.](http://web.archive.org./web/20170829083154im_/https://www.fairfaxstatic.com.au/content/dam/images/g/r/j/8/f/3/image.related.articleLeadwide.620x349.gxzztr.png/1503656497745.jpg)
Don't take my word for it. This month a group of extremely influential Australian healthcare organisations – including health professionals, consumers and policy-makers – endorsed a call to action to address the problem.
"Alongside the undisputed ability of healthcare to extend human life and ameliorate suffering," reads the call to action, "there is growing evidence and concern about the problem of too much medicine."
The statement follows a national summit in July at the University of Sydney, attended by 60 leading stakeholders and researchers, which concluded its time for action. "Overdiagnosis and the related overuse of medical tests and treatments not only causes harm, but also diverts resources from addressing underdiagnosis and undertreatment," reads this month's statement.
One of the big areas of concern is the overdiagnosis of cancer. Many readers might already be familiar with the problem for prostate cancer. If you test and screen lots of healthy men, along with detecting the deadly cancers, you'll find cancers in many men that would never have gone on to cause them harm.
Less well known is that overdiagnosis is also a problem in breast cancer screening. Its difficult to get exact figures, but a recent estimate from The Lancet suggested as many as one in five of the cancers detected via screening may be overdiagnosed – in that they would never have caused harm.
Notwithstanding this problem, the strong view of public health authorities including the Cancer Council of Australia is that the benefits of breast cancer screening, including a reduction in the number of early deaths from the disease, outweigh the harms, including overdiagnosis.
![The problem of medical excess is finally being acknowledged.](http://web.archive.org./web/20170829083154im_/https://www.fairfaxstatic.com.au/content/dam/images/g/y/3/e/l/i/image.related.articleLeadwide.620x349.gxzztr.png/1503802442889.jpg)
One of the most disturbing examples is thyroid cancer. Australia, like other places, has experienced a massive increase in diagnoses of thyroid cancer – a tripling in recent decades – mostly involving smaller cancers. Researchers are coming to the conclusion that a lot of those newly diagnosed cancers would not in fact cause any harm. By contrast the surgical treatment of them carries real risks, and you can end up having to take life-long medication. Recent research suggested up to 10,000 Australians may have been overdiagnosed with thyroid cancer in the past two decades.
With all these examples, it's complicated. Rarely is there complete certainty about which cancers will go on to harm and which won't. What is certain though is that the current system is labelling, diagnosing and treating too many people. And it's not just in cancer.
With colleagues, I've published a comprehensive analysis in the British Medical Journal of what's driving this problem, and where the solutions might lie. Along with our beliefs that "more is better" and our blind faith in early detection, there are of course all the financial incentives driving doctors and healthcare companies to do more tests and treatments.
Another of the causes is the expanding definitions of diseases – the lowering of diagnostic thresholds which label more and more people with milder problems, or who are at lower risk of illness: people previously considered perfectly healthy. One in three people are now said to have "pre-diabetes". There's concern normal cognitive changes as we age are labelled as "pre-dementia". And "pre-osteoporosis" is a non-condition that frightens millions unnecessarily: in reality simply being "at risk" of being "at risk" of having a bone fracture.
The good news is that this problem of medical excess is finally being acknowledged – and powerful organisations are exploring solutions. The national call to action on overdiagnosis has been endorsed by the Royal College of Physicians – which helps train and represents more than 20,000 medical specialists, the colleges of GPs and radiologists. The Consumer's Health Forum has also thrown its weight behind it, as has the Australian Commission on Safety and Quality in Healthcare and the Cancer Council of Australia.
The more cynical readers will rightly point out that a call to action will achieve little on its own, and that the commercial forces driving excess are much larger than the voices calling for quality over quantity.
As someone who's been writing about the problem of too much medicine for longer than I care to mention, no one should underestimate the importance of this month's announcement. Its no miracle cure, but the culture of medicine is changing.
But until it does, a strong dose of healthy evidence-based scepticism is highly recommended. Don't just ask, do I really need that drug? But a lot more often, we need to ask, do I really need that diagnosis?
Dr Ray Moynihan is a senior research fellow at Bond University and chaired the planning committee for the national summit on overdiagnosis.
0 comments
New User? Sign up