Winding back the harms of too much medicine

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1271 (Published 26 February 2013)
Cite this as: BMJ 2013;346:f1271

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  1. Ray Moynihan, senior research fellow1,
  2. Paul Glasziou, professor1,
  3. Steven Woloshin, professor of community and family medicine2,
  4. Lisa Schwartz, professor of community and family medicine2,
  5. John Santa, director of health ratings centre3,
  6. Fiona Godlee, editor, BMJ4
  1. 1Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QSD 4229, Australia
  2. 2Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
  3. 3Consumer Reports, New York, USA
  4. 4BMJ, London WC1H 9JR, UK
  1. fgodlee{at}bmj.com

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Distinguishing the sick from the healthy has always been a fundamental challenge for medicine. A chief concern has been to guard against missing disease, with the focus on problems of underdiagnosis and undertreatment. Yet with the modern technological expansion of healthcare in rich developed nations, sceptical voices have long warned of the flipside—too much medicine.1 2 Mounting evidence about the threat to human health from overdiagnosis,3 and the harms and waste from unnecessary tests and treatments,4 5 now demand that we meet one of this century’s key challenges: how to wind back medical excess, safely and fairly.

In 2002 the BMJ published a theme issue called “Too Much Medicine?” with articles on the medicalisation of birth, sex, and death, among other aspects of ordinary life. Its opening editorial wondered whether doctors could become pioneers of de-medicalisation, handing back power to patients, resisting disease mongering, and demanding fairer global distribution of effective treatments.6 A decade later, as data on overuse and overdiagnosis mount,3 the BMJ announces a “Too Much Medicine” campaign—this time without the question mark (www.bmj.com/too-much-medicine). …

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