New way to define disease is needed to reduce overdiagnosis
A new process is needed for defining diseases that takes account of the potential risks of overdiagnosis and overtreatment as well as the benefits of appropriate diagnosis and care, researchers, policymakers, and consumer groups agreed at an international congress this week.
“The problem at the moment is that we don’t have an internationally agreed process,”
said Paul Glasziou, professor of evidence based practice at Bond University, Robina, Queensland.
“Disease definitions are developed on a very ad hoc basis, often by guideline panels making recommendations about tests and treatments who, along the way, incidentally change the definition of a disease,”
“We have a clear, internationally agreed process on what evidence is needed to recommend a particular treatment. But there has been a neglect of the fundamental issue that comes before that, which is the definition of disease.”
Over the past 30 years, awareness and screening have led to an emphasis on early diagnosis of cancer.
Although the goals of these efforts were to reduce the rate of late-stage disease and decrease cancer mortality, secular trends and clinical trials suggest that these goals have not been met; national data demonstrate significant increases in early-stage disease, without a proportional decline in later-stage disease.
Unbelievable scam of cancer industry blown wide open: $100 billion a year spent on toxic chemotherapy for many FAKE diagnoses… National Cancer Institute’s shocking admission affects millions of patients, natural news, October 08, 2015.
What has emerged has been an appreciation of the complexity of the pathologic condition called cancer. The word “cancer” often invokes the specter of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime.
Overdiagnosis and Overtreatment in Cancer, An Opportunity for Improvement, JAMA, August 28, 2013.
Better biology alone can explain better outcomes. Although this complexity complicates the goal of early diagnosis, its recognition provides an opportunity to adapt cancer screening with a focus on identifying and treating those conditions most likely associated with morbidity and mortality.
Porté par des enjeux humains et de santé publique, le documentaire suit le parcours de quatre femmes confrontées, un jour, à la peur du cancer du sein. Leurs histoires sont le point de départ d’une enquête scientifique qui bouscule nos certitudes..
Tous les ans au mois d’octobre, la campagne pour le dépistage bat son plein. Mais depuis quelques années, la controverse monte:
Advances in medicine have propelled health care to new heights and a vast array of diagnostic tests and drug therapies is now available. But are we getting too much of a good thing?
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An increasing number of doctors now say that sometimes, “less is more” when it comes to medical interventions. Some doctors are concerned that resources are being wasted on the “worried well” and that the ever-expanding definition of how we define “disease” has been influenced by vested interests. Could excessive medical interventions be causing more harm than good?
Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures.
More info and videos
Dr. Mike Evans is a staff physician at St. Michael’s Hospital and an Associate Professor of Family Medicine. He is a Scientist at the Li Ka Shing Knowledge Institute and has an endowed Chair in Patient Engagement in Child Nutrition at the University of Toronto. Check out his new website.
Astounding Number of Medical Procedures Have No Benefit, Even Harm
2015 Study Abstract
Overuse of medical care, consisting primarily of overdiagnosis and overtreatment, is a common clinical problem.
To identify and highlight articles published in 2014 that are most likely to influence medical overuse, organized into the categories of overdiagnosis, overtreatment, and methods to avoid overuse, and to review these articles and interpret them for their importance to clinical medicine.
A structured review of English-language articles in PubMed published in 2014 and a review of tables of contents of relevant journals to identify potential articles that related to medical overuse in adults.
We reviewed 910 articles, of which 440 addressed medical overuse. Of these, 104 were deemed most relevant based on the presentation of original data, quality of methods, magnitude of clinical effect, and number of patients potentially affected. The 10 most influential articles were selected by author consensus using the same criteria. Findings included
lack of benefit for screening pelvic examinations (positive predictive value <5%),
carotid artery screening (no reduction in stroke),
and thyroid ultrasonography (15-fold increase in thyroid cancer).
The harms of cancer screening included
Head computed tomography was an overused diagnostic test (clinically significant findings in 4% [7 of 172] of head computed tomographic scans).
acetaminophen for low back pain,
perioperative aspirin use,
medications to increase high-density lipoprotein cholesterol level,
stenting for renal artery stenosis,
and prolonged opioid use after surgery (use >90 days in 3% [1229 of 39 140] of patients).
CONCLUSIONS AND RELEVANCE:
Many common medical practices should be reconsidered. It is anticipated that our review will promote reflection on these 10 articles and lead to questioning of other non-evidence-based practices.
For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We’ve left out of our tally the most impactful expenditures countries make to improve the health of their populations—investments in social services.
In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.
Offering a unique and clarifying perspective on the problems the Affordable Care Act won’t solve, this book also points a new way forward.
International conference at the University of Roehampton, 2015
CEP is pleased to announce that its upcoming conference More Harm than Good: Confronting the Psychiatric Medication Epidemic will be ‘live streamed’ via YouTube on 18 September. This means that anyone with an Internet connection can watch the conference for free in real time. In addition, each of the talks will be filmed and posted onto the CEP website for later viewing.
There are two streams to view.
The first starts at 9am BST (GMT+1) and will record the morning session here.
The second starts at 2pm BST (GMT+1) and will record the afternoon session here.