This is a lovely feature piece in the BMJ concisely detailing that surging occult demon consuming healthcare resources under the guise of “improved health” – overdiagnosis. It’s really quite lovely to see the cultural changes coming in medicine, where increasing awareness of costs in the face of questionable benefit will reshape our profession in the years to come.
These authors, from Australia, describe twelve categories of “disease” that are expanding without obvious clinical benefit, as well as a brief overview of the sorts of practices that drive overdiagnosis. It’s a bit of a lead-in to next year’s conference, Preventing Overdiagnosis, at Dartmouth University.
The entire article is worth reading, but I thought their table with the drivers of overdiagnosis was a nice summary:
- Technological changes detecting ever smaller “abnormalities”
- Commercial and professional vested interests
- Conflicted panels producing expanded disease definitions and writing guidelines
- Legal incentives that punish underdiagnosis but not overdiagnosis
- Health system incentives favouring more tests and treatments
- Cultural beliefs that more is better; faith in early detection unmodified by its risks