Medicalisation

Preventing overdiagnosis: how to stop harming the healthy

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3502 (Published 29 May 2012)
Cite this as: BMJ 2012;344:e3502

Get access to this article and all of bmj.com for the next 14 days

Sign up for a 14 day free trial today

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

  1. Ray Moynihan, senior research fellow 1,
  2. Jenny Doust, professor of clinical epidemiology2,
  3. David Henry, chief executive officer3
  1. 1Bond University, Robina, Queensland, Australia
  2. 2Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Australia
  3. 3Institute for Clinical Evaluative Sciences, Toronto, Canada
  1. Correspondence to: R Moynihan raymoynihan{at}bond.edu.au

Evidence is mounting that medicine is harming healthy people through ever earlier detection and ever wider definition of disease. With the announcement of an international conference to improve understanding of the problem of overdiagnosis, Ray Moynihan, Jenny Doust, and David Henry examine its causes and explore solutions

Medicine’s much hailed ability to help the sick is fast being challenged by its propensity to harm the healthy. A burgeoning scientific literature is fuelling public concerns that too many people are being overdosed,1 overtreated,2 and overdiagnosed.3 Screening programmes are detecting early cancers that will never cause symptoms or death,4 sensitive diagnostic technologies identify “abnormalities” so tiny they will remain benign,5 while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them.3 6 With estimates that more than $200bn (£128bn; €160bn) may be wasted on unnecessary treatment every year in the United States,7 the cumulative burden from overdiagnosis poses a significant threat to human health.

Narrowly defined, overdiagnosis occurs when people without symptoms are diagnosed with a disease that ultimately will not cause them to experience symptoms or early death.3 More broadly defined, overdiagnosis refers to the related problems of overmedicalisation and subsequent overtreatment, diagnosis creep, shifting thresholds, and disease mongering, all processes helping to reclassify healthy people with mild problems or at low risk as sick.8

The downsides of overdiagnosis include the negative effects of unnecessary labelling, the harms of unneeded tests and therapies, and the opportunity cost of wasted resources that could be better used to treat or prevent genuine illness. The challenge is to articulate the nature and extent of the problem more widely, identify the patterns and drivers, and develop a suite of …

Get access to this article and all of bmj.com for the next 14 days

Sign up for a 14 day free trial today

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Article access

Article access for 1 day

Purchase this article for £20 $30 €32*

The PDF version can be downloaded as your personal record

* Prices do not include VAT

THIS WEEK'S POLL