Re: Too much medicine; too little care
The editorial by Glasziou and colleagues raises concern that the laudable aim for the transition of medicine from the treatment of disease to the prevention of its occurence could be harmed by the thrust of the Too Much Medicine series.1 The editorial opens the subject of overdiagnosis in general, and discusses the dual harms of treatment and patient anxiety which increase as diagnostic parameters shift in illnesses such as hypertension, high cholesterol, diabetes and osteoporosis. This is a one-sided view which makes no mention of the benefits for patients of primary prevention, which is only possible due to the early detection of risk factors before they become apparent, for example when a patient presents with central crushing chest pain. Cardiovascular disease was described in 2009 by the World Health Organisation as the number one cause of death world wide.2 Primary prevention by modification of multiple risk factors including hypertension and raised cholesterol reduces incidence of cardiovascular disease.3
While in certain areas, such as the unnecessary treatment of incidentally found PE, there should be an evaluation of medicine's increasing tendency to uncover and treat parameters which fall out of the normal range before they cause problems, if indeed problems are to arise at all, in other areas the strategy of investigation and treatment for known risk factors has been proven to be effective, and is not "Too Much Medicine".4
1. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine; too little care. BMJ 2013;347;f4247
2. Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull. 2009;92:7-32.
3. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80% BMJ. 2003;13(7404):1419.
4. Wiener RS, Schwartz LM, Woloshin S. When a test is too good. BMJ 2013;347:f3368.
Competing interests: No competing interests