Overtreatment can be cured only by educationBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6867 (Published 06 November 2012) Cite this as: BMJ 2012;345:e6867
- Huw Llewelyn, general physician and endocrinologist, honorary fellow1
Overtreatment results from suboptimal selection of patients for treatment during the diagnostic process. Currently, evidence based medicine is mainly concerned with diagnostic screening and therapeutics, especially randomised clinical trials. However, the criteria for diagnosis and treatment, and tests useful in differential diagnosis, are not being chosen in an evidence based way.1 2 Professional organisations in the US and UK, the National Institute for Health and Clinical Excellence, and the Cochrane Collaboration therefore cannot provide guidelines based on evidence based diagnostic and treatment selection criteria. Commercial organisations also use non-evidence based treatment selection criteria to promote their products.
This situation is reflected by the various opinions in the BMJ of 6 October that patients do not have the intellectual basis to participate in informed decisions,3 4 that clinical trials assess effectiveness only in “average” patients,5 that profit seeking drives overtreatment,6 and that overtreatment may increase with commercialisation of the NHS.7 The solution lies in appropriate medical education. All doctors should be taught how to analyse clinical trials so that they can work out which patients would benefit most from treatment (for example, at what degree of disease severity) and arrive at treatment indication criteria in an evidence based way.1 8 If the General Medical Council and other national regulatory bodies representing patients’ interests insisted on doctors being trained to justify diagnosis and treatment selection in a transparent and explicit way, there might be more demand for research to support such training.
Cite this as: BMJ 2012;345:e6867
Competing interests: None declared.