Analysis Too Much Medicine

Mapping the drivers of overdiagnosis to potential solutions

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3879 (Published 16 August 2017) Cite this as: BMJ 2017;358:j3879
  1. Thanya Pathirana, PhD scholar,
  2. Justin Clark, senior information specialist,
  3. Ray Moynihan, senior research fellow
  1. Center for Research in Evidence Based Practice, Bond University, Australia
  1. Correspondence to: R Moynihan rmoyniha{at}bond.edu.au

Thanya Pathirana and colleagues explore strategies to tackle the problem of too much medicine

Key messages

  • Interest is growing in tackling the problems of overdiagnosis and overtreatment

  • Possible drivers and potential solutions arise across five inter-related domains: culture, the health system, industry and technology, healthcare professionals, and patients and the public

  • More work is needed to develop and evaluate interventions aimed at preventing overdiagnosis

  • Raising public awareness of overdiagnosis is a priority

In our collective enthusiasm to diagnose and treat disease, a growing body of evidence indicates that we may often be doing too much of a good thing.12345 “Overdiagnosis” is now widely recognised to occur when people are labelled with or treated for a disease that would never cause them harm—often as a result of undergoing screening—and it can lead to the overuse of further tests and treatments.26 One example is thyroid cancer, with estimates that over 500 000 people may have received overdiagnoses across 12 countries in the past two decades, leading to unnecessary surgery and lifelong medication for many.7

Overdiagnosis is a challenge to the sustainability of human health and health systems. Its causes—including the best of intentions—are as complex and multifaceted as the potential solutions.8910111213 As part of the preparation for a possible national action plan in Australia, we searched the literature for causes of and responses to overdiagnosis. Here we provide the first comprehensive analysis of the possible drivers of overdiagnosis and related overuse, mapped to potential solutions.

Searching the literature

Our approach to the initial and updated PubMed searches of the literature is outlined in the data supplement (see bmj.com) and yielded a total of 36 articles, to which we added a further five (fig 1). We included articles that explicitly discussed possible drivers …

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