Winding back the harms of too much medicine

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). …