Too Much Medicine, a Campaign by The BMJ

The threat to human health posed by overdiagnosis and the waste of resources on unnecessary care

The BMJ logo
BMJ Launched ‘its Too Much Medicine‘ Campaign in 2013 To Tackle The Harms Of Overdiagnosis And Overtreatment.

In 2002 the BMJ published a theme issue called “Too Much Medicine?” with articles on the medicalisation of birth, sex, and death, among other aspects of ordinary life. Its opening editorial wondered whether doctors could become pioneers of de-medicalisation, handing back power to patients, resisting disease mongering, and demanding fairer global distribution of effective treatments.

A decade later, as data on overuse and overdiagnosis mount the BMJ announces its Too Much Medicine campaign aiming to highlight the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care.

There is growing evidence that many people are overdiagnosed and overtreated for a wide range of conditions, such as prostate and thyroid cancers, asthma, and chronic kidney disease.

Through the campaign, the journal plans to work with others to increase awareness of the benefits and harms of treatments and technologies and develop ways to wind back medical excess, safely and fairly. This editorial by Fiona Godlee, editor in chief of The BMJ and overdiagnosis researcher Ray Moynihan, senior research fellow at Bond University, Australia, explains more about the campaign:

Dr Godlee said: “Like the evidence based medicine and quality and safety movements of previous decades, combatting excess is a contemporary manifestation of a much older desire to avoid doing harm when we try to help or heal.

Making such efforts even more necessary are the growing concerns about escalating healthcare spending and the threats to health from climate change. Winding back unnecessary tests and treatments, unhelpful labels and diagnoses won’t only benefit those who directly avoid harm, it can also help us create a more sustainable future.”

The BMJ was a partner in the international scientific conference, Preventing Overdiagnosis, held in September 2013 in Hanover, New Hampshire. The conference brought together the research and researchers, advanced the science of the problem and its solutions, and developed ways to better communicate about this modern epidemic.

Sources and More Information:

  • Too much medicine, BMJ, 2013.
  • BMJ Launches ‘Too Much Medicine’ Campaign To Tackle The Harms Of Overdiagnosis And Overtreatment, MNT, releases/256903, 26 February 2013.
  • Winding back the harms of too much medicine, BMJ, 346:f1271, 26 February 2013.

Do Doctors always use evidence to help Patients make Decisions?

Guidelines are useful but make sure you know the evidence or lack thereof

Some Studies that I like to quote

A parody song designed to get you thinking about the problem with strictly following (cardiovascular guidelines/target shooting) and NOT using evidence to help you and your patient make decisions. The lab coat logos are from top drug companies, top Rx medications and top guideline producers. Guidelines are useful but make sure you know the evidence or lack thereof.

More information

Testing Treatments Interactive free Book, Better Research for Better HealthCare

This book should be in every school, and every medical waiting room says Ben Goldacre

image of Testing Treatments Interactive Book
Click for free download.

The 2nd edition of Testing Treatments was published in 2011. It urges everyone to get involved in improving current research and future treatment, and outlines practical steps that patients and health professionals can take together to do this.

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in the free book written by Imogen Evans, Hazel Thornton, Sir Iain Chalmers and Paul Glasziou.

The full text of the 2nd edition is available for free download, and the paperback and ebook editions can be purchased from the publisher or from online booksellers. The text is already available in some other languages, and translations into additional languages are being prepared.

Sources:

Introducing “Testing Treatments Interactive”

Promoting Better Research for Better HealthCare, 2014

Sir Iain Chalmers explains why fair tests of the effects of treatments can improve healthcare.

More information

The Healthcare Hashtag Project

An awesome, very useful Twitter tool…

Why the Healthcare Hashtag Project?
Learn, engage and contribute to the Healthcare Hashtag Project

Objective:The goal of the Healthcare Hashtag Project by @symplur is to make the use of healthcare social media and Twitter more accessible for the healthcare community as a whole. By lowering the learning curve of Twitter with a database of relevant hashtags to follow, Symplur hope to help new and existing users alike to find the conversations that are of interest and importance.

Why the Healthcare Hashtag Project?

  • DISCOVER WHERE THE HEALTHCARE CONVERSATIONS ARE TAKING PLACE
  • DISCOVER WHO TO FOLLOW WITHIN YOUR SPECIALTY OR DISEASE
  • DISCOVER THE BEST FROM CONFERENCES IN REAL-TIME OR IN ARCHIVE
DiEthilStilbestrol hashtags
#diethylstilbestrol hashtag influencers and engagers

What can you find?

Contribute to The Healthcare Hashtag Project:

  1. Authenticate with Twitter
  2. Select Hashtag Type
  3. Enter Information and Submit

Top Reasons Patients sue Doctors: missed Diagnoses and Drug Errors

Identifying early warning signs for diagnostic errors in primary care: a qualitative study

Failure to diagnose is No.1 reason for suing doctors
Failure to diagnose is No.1 reason for suing doctors

Missed diagnoses ― particularly of cancer, heart attack, and meningitis ― and drug errors make up the bulk of malpractice claims brought against doctors in primary care, finds an analysis of published data in BMJ Open.

Abstract

Objective
We investigate the mechanisms of diagnostic error in primary care consultations to detect warning signs for possible error. We aim to identify places in the diagnostic reasoning process associated with major risk indicators.

Design
A qualitative study using semistructured interviews with open-ended questions.

Setting
A 2-month study in primary care conducted in Oxfordshire, UK.

Participants
We approached about 25 experienced general practitioners by email or word of mouth, 15 volunteered for the interviews and were available at a convenient time.

Intervention
Interview transcripts provided 45 cases of error. Three researchers searched these independently for underlying themes in relation to our conceptual framework.

Outcome measures
Locating steps in the diagnostic reasoning process associated with major risk of error and detecting warning signs that can alert clinicians to increased risk of error.

Results
Initiation and closure of the cognitive process are most exposed to risk of error. Cognitive biases developed early in the process lead to errors at the end. These warning signs can be used to alert clinicians to the increased risk of diagnostic error. Ignoring red flags or critical cues was related to processes being biased through the initial frame, but equally well, it could be explained by knowledge gaps.

Conclusions
Cognitive biases developed at the initial framing of the problem relate to errors at the end of the process. We refer to these biases as warning signs that can alert clinicians to the increased risk of diagnostic error. We conclude that lack of knowledge is likely to be an important factor in diagnostic error. Reducing diagnostic errors in primary care should focus on early and systematic recognition of errors including near misses, and a continuing professional development environment that promotes reflection in action to highlight possible causes of process bias and of knowledge gaps.

How We Do Harm

A Doctor breaks ranks about being sick in America

A Doctor breaks ranks about being sick in America
How We Do Harm

How We Do Harm exposes the underbelly of healthcare today—the overtreatment of the rich, the under treatment of the poor, the financial conflicts of interest that determine the care that physicians’ provide, insurance companies that don’t demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm.

Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (but as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary—and often unproven—treatments that we all pay for. Brawley calls for rational healthcare, healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs.

Brawley’s personal history – from a childhood in the gang-ridden streets of black Detroit, to the green hallways of Grady Memorial Hospital, the largest public hospital in the U.S., to the boardrooms of The American Cancer Society—results in a passionate view of medicine and the politics of illness in America – and a deep understanding of healthcare today. How We Do Harm is his well-reasoned manifesto for change.

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Statistics prove that Prescription Drugs are 16,400% more deadly than Terrorists…

The corruption in the pharmaceutical industry and in America’s healthcare system poses a far greater threat to the health, safety and welfare of Americans today than terrorism

Statistics prove that Prescription Drugs are 16,400% more deadly than Terrorists...

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Majority of Doctors support limited Access only to our own Electronic Records

Doctors are not in favour of full transparency

Read Majority of doctors opposed to full access to your own electronic records by Ken FisherA recent survey … reveals that doctors aren’t big fans of full transparency… 65 percent, supported “limited access,” … 4 percent believe there should be no access granted to patients… despite the fact that we have rights to review and amend our records, doctors don’t want it to be easy for us to do so via electronic means…

Read Majority of doctors opposed to full access to your own electronic records by Ken Fisher