Observations Reality Check

Overdiagnosis and the dangers of early detection

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d1140 (Published 23 February 2011) Cite this as: BMJ 2011;342:d1140
  1. Ray Moynihan, author, journalist, and conjoint lecturer, University of Newcastle, Australia
  1. Ray.Moynihan{at}newcastle.edu.au

A new book calls for greater awareness of the potential harms of early diagnosis

How often it is in matters medical that the truth feels strange and counterintuitive, seduced as we are by so many false yet familiar assumptions: newer is better; widely used procedures are all proved; a registered drug must surely be a safe one. But perhaps the unhealthiest fallacy of all is the popular conviction that early detection is always for the best. A powerful new book from a team of Ivy League doctors claims that overdiagnosis is one of medicine’s biggest problems, causing millions of people to become patients unnecessarily, producing untold harm, and wasting vast amounts of resources.

Over-diagnosed: Making People Sick in the Pursuit of Health (www.beacon.org/productdetails.cfm?SKU=2200) is written by three widely published researchers, Gilbert Welch, Lisa Schwartz, and Steve Woloshin. They’re all based at the Dartmouth Medical School in New Hampshire and known for rigour and scepticism. All three are practising doctors and scientists and are well aware that in many, many cases early diagnosis can ameliorate suffering and extend life. But as the evidence makes clear, too often …

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