Are you being “over-diagnosed”?

According to a trio of widely published American researchers, many of us are “over-diagnosed” by being labelled with a medical condition that will never cause us any symptoms or premature death. We are, they tell us, mistakenly swallowing the popular conviction that early detection of everything is always for the best.

Their book, Over-diagnosed: Making People Sick in the Pursuit of Health, claims that over-diagnosis is in fact one of medicine’s biggest problems, causing millions of people to become patients unnecessarily, producing untold harm, and wasting vast amounts of resources in the name of disease mongering.

And, as these authors remind us, people whose conditions are over-diagnosed can never benefit from treatment, but they can only be harmed.  Their book includes these themes:

  • how test numbers get changed to give you diabetes, high cholesterol and osteoporosis
  • how scans give you gallstones, damaged knee cartilage, bulging discs, abdominal aortic aneurysms and blood clots
  • over-diagnosis of prostate cancer, breast cancer and other cancers
  • stumbling onto “incidentalomas” that might be cancer
  • how genetic testing will give you almost anything
  • how screening gives you (and your baby) another set of problems

The book is written by three Ivy League academics, Drs. Gilbert Welch, Lisa Schwartz, and Steve Woloshin of Dartmouth Medical School in New Hampshire.  All three are researchers and practicing physicians who claim, although they do acknowledge that early diagnosis can indeed reduce suffering and extend life in many case, that we are nonetheless being diagnosed with medical conditions that are in fact not diseases, but, in an alarmingly trend, are simply risk factors portrayed as diseases.

Australian investigative journalist Ray Moynihan, co-author with Alan Cassels of the book Selling Sickness (about the medicalization of everyday life) wrote this about the book Over-diagnosed in the British Medical Journal last month:

“The widespread promotion of preventive drugs for high blood pressure, high cholesterol, high blood sugar concentrations, and low bone mineral density is costing vast amounts of public resources globally, despite doubts about whether this is money well spent. (Järvinen T, Sievänen H, Kannus P, Jokihaara J, Khan K, “Pharmacological disease prevention: is it cost effective?” BMJ, forthcoming)

“The definitions of these so-called diseases have changed in recent decades, with boundaries being widened and treatment thresholds being lowered, dramatically expanding the number of people classed as patients simply because they’re at risk of future bad events.

“For example, broader definitions of high blood pressure brought a 35% jump in the number of people classed as sick, while a changed definition of high cholesterol meant that tens of millions more people became patients.

“But, as people at lower risk are treated, the chances that those treatments will help them fall and the number of people you need to treat unnecessarily so as to help one person rises dramatically – what researchers call NNT – “numbers needed to treat”.

“If you treat people with severely high blood pressure for five years, the chance of preventing a bad event is almost 80%, thus you are helping almost everyone you treat. But for those with only mild hypertension, the chance of benefit is closer to 5%, so 95% of people are treated for five years without any benefit.

“Another calculation estimates the value of taking lifelong drug treatment for mild or “near-normal” osteoporosis. Only 5% of people with mild osteoporosis are saved from a fracture, so the other 95% are exposed to the potential harms of the drugs with no benefit.

“These figures are scandalous, given the side effects of popular osteoporosis drugs, which can include:

  • ulceration
  • osteonecrosis of the jaw
  • atypical fractures

“These figures also add weight to calls for a rethink of how we treat these risk-based conditions and why we target so many healthy people with “preventive” drugs.”

Read the rest of Ray Moynihan’s article in the British Medical Journal.

See also:

4 thoughts on “Are you being “over-diagnosed”?

  1. Another awesome post! Until we the consumers (oops – I mean potential patient population) say enough is enough and stop taking the pills, change our lifestyles, and look at what’s on the end of our forks, we are only going to get sicker and sicker.

    Growing up, the only “medicine” in the cabinet was aspirin, witch hazel, hydrogen peroxide, some bandaids, iodine and tincture soap. What was in yours?

    Thanks again for keeping us so well informed.

  2. You are 100% right – we have been medicalized from birth to death and every possible normal human experience in between. The pharmaceutical industry is in trouble (closing plants, moving offshore, laying off staff) so inventing new “diseases” is their one hope for keeping up sales revenues.

  3. Business is business, and as long as we continue to allow our health care decisions to be made by corporations and other organizations that put money ahead of patient well-being, this will continue to happen. It’s capitalism at work.

    Unfortunately, these organizations are also involved in “educating” patients (and doctors) about what is illness and what is not. And in my field of psychiatry, educating patients (or “raising awareness”) often plants the seed of worry, and doctors rarely reassure patients that they’re actually okay.

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