Too much medicine; too little care

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4247 (Published 02 July 2013) Cite this as: BMJ 2013;347:f4247

Re: Too much medicine; too little care

I fully agree that Overdiagnosis and Overtreatment is a manifest danger in the modern NHS - screening by PSA for prostate Cancer, or Ultrasound for Aortic Aneurysm being egregious examples.

But this will require much more precise definition of terms.. The article states that Overdiagnosis should be suspected if "The incidence is increasing while mortality stays the same", and elsewhere refers to 'death rate'.

"One striking example is the tripling of the incidence of thyroid cancer in the United States, Australia, and elsewhere between 1975 and 2012,2 3 during which time the death rate did not change. This dramatic rise is best explained by increased testing and improved diagnostic tools, rather than a real change in cancer incidence. "

This example might indicate overdiagnosis , if death rate referred to the whole population. A case-specific death rate which remained the same would suggest that true disease incidence was indeed increasing, or worse, that 'benign cases' were increasingly detected, and then actively harmed by treatment !!

The Australian Cancer experience cited gives prevalence, incidence, and 'death rate' a more thorough examination

Competing interests: No competing interests

09 July 2013
L Sam Lewis
GP Trainer
Surgery, Newport, Pembrokeshire SA42 0TJ