The challenge of preventing overdiagnosis

Iona Heath was a general practitioner in inner-city London for 35 years and is a Past President of the UK Royal College of General Practitioners.  She is a co-chair of the Scientific Committee for the 2017 Preventing Overdiagnosis conference

 

Over the past several decades, the economic interests of the pharmaceutical and medical technology industries have both pressured and tempted medicine to overextend itself.  The traditional moral commitment of the medical profession to relieve suffering and to care for the dying has been gradually displaced by a futile and misguided attempt to solve humanity’s most profound existential problems through biotechnical means.  Doctors now apply more and more powerful treatments towards the end of life and try to prevent diseases by seeking out and correcting more and more risk factors.  All this has led to an epidemic of overdiagnosis and overtreatment affecting us all, but perhaps particularly harming the old.  These endeavours deflect our attention from the fundamental need to find meaning in the face of the universal human experience of suffering, loss and death.  Death itself comes to be regarded as a failure of medicine and doctors, rather than the inevitable culmination of every life.

EvaluatePharma describes itself as an organization that provides senior decision makers within the pharmaceutical industry with models of the sector from the viewpoint of the world’s financial markets. Its strapline offers to identify “When you can easily determine that a new therapy category is a market opportunity”, and a logo shows more and more people being swallowed up into a funnel.  According to their world preview 2014, for the first time in the pharmaceutical industry’s history, the consensus forecast of worldwide prescription drug sales was set to exceed one trillion dollars, reaching $1,017bn by 2020, which equates to an average growth of 5.1% per year from 2013 to 2020. Worldwide prescription drug sales will have almost doubled in just 14 years.  These gigantic profits depend entirely on us all being persuaded to take an enormous and rapidly increasing number of medications – and then peeing them out into the already beleaguered environment.

Meanwhile, the medical technology industry produces machines capable of investigating the human body in ever greater detail, revealing changes that challenge our ideas about what is normal and which are leading to the identification and treatment of apparently abnormal findings that would never have caused a problem to the patient in their lifetime if left untreated.  Incidence rises, but mortality rates remain the same: a pattern that is becoming pathognomic of overdiagnosis.

Everyone, to a greater or lesser extent, is afraid of dying and of life-changing disease.  Tragically, this pervasive fear works to the advantage of the medical-industrial complex and, as a result, is fanned in the interests of corporate profit.  The systematic medicalization of ordinary human distress has turned into an epidemic of disease-mongering, which actively inflates fear and plays on the resulting insecurity deliberately for financial gain.  Fear also sells newspapers, and so many journalists, and almost all editors, play their parts willingly.  Benign symptoms are portrayed as serious disease, as in irritable bowel syndrome; personal or social problems are recast as medical ones, as in much mild depression; and risks are conceptualized as diseases, as in reduced bone density, mildly raised blood pressure, and type 2 diabetes.

Doctors and other health professionals are gradually beginning to understand that they may now find themselves in the unfortunate position of doing harm while trying to do good; academic researchers are working to investigate the extent and effects of overdiagnosis, and how it might be mitigated; and journalists and policy-makers seem finally to be beginning to take the issue seriously by promoting greater public debate.

The first international Preventing Overdiagnosis conference brought all these different interest groups together in Dartmouth, USA, in 2013 and highly successful conferences have been held every year since.

The 2017 conference is to be hosted by the Quebec Medical Association and held in Quebec City, August 17-19, 2017. The principal themes will be overuse and overmedicalization, moving from evidence to action, communicating about overdiagnosis, and engaging with citizens, patients and the public.

The call for abstracts is now open.

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