People immediately understand misdiagnosis, but the concept of overdiagnosis can be harder to grasp, especially when stories of people getting bad or inadequate care dominates headlines. When it comes to healthcare, is there any harm in getting too much?
The story of Barbara from Boynton Beach, Florida serves to illustrate how people sometimes do better with less. When routine bone density tests revealed mild bone loss, Barbara was diagnosed with “osteopenia.” Barbara’s doctor–like many other physicians across the U.S.–immediately recommended bone-building drugs. But having read of the side effects of such medications, and given that Barbara did not have osteoporosis—a marked loss of bone density, Barbara convinced her physician to let her try lifestyle changes such as diet and exercise instead. A year later, when Barbara’s test results were in the healthy range, her doctor finally conceded that the drugs weren’t needed.
Barbara’s story is, unfortunately, is not typical. The U.S. spend more than $200 million on unnecessary medical care every year, according to estimates by the British Medical Journal. Ever more screening tests, combined with the broadening of how society defines disease has led to patients being subjected to an increasing number of tests and treatments they do not need and may even cause them harm.
Unlike Barbara, many people do not have access to the kind of information they need to participate fully in decisions about their care. And in many cases, there is no bright line between appropriate and inappropriate care. But how do you know how much care is too much? And what can be done to root out and reverse those instances of overdiagnosis and overtreatment that have become embedded in the healthcare system.
To address these issues, scientists, clinicians, policy-makers, and consumer advocates from nearly 30 countries across 6 continents recently convened at the first ever scientific conference on overdiagnosis at Dartmouth College in Hanover, New Hampshire.
Following its support of programs such as Choosing Wisely, in which national medical societies define commonly overused tests and procedures, Consumer Reports has joined the Preventing Overdiagnosis Conference as a partner and consumer translator for this important series of topics. Other members of the organizing alliance include the British Medical Journal, one of the world’s most respected medical journals as well as The Dartmouth Institute for Health Policy and Clinical Practice and Australia’s Bond University.
In an impressive first step in tackling the problem of overdiagnosis, conference participants identified the following priorities:
- Strengthen the science underpinning the study of overdiagnosis, developing methods to measure the problem and evaluating strategies to maximise benefits and minimise harms of health care.
- Develop ways to incorporate education about overdiagnosis into standard clinical training for health professionals and students.
- Develop effective ways to inform the public and policy-makers about what are often complex and even counterintuitive issues.
- Build on efforts in health systems around the world to reduce overdiagnosis. That includes combating reimbursement systems that often reward physicians and hospitals for quantity rather than the quality of care as well as expanding definitions of disease. The conference sought to rigorously examine the benefits and harms of some changes in disease definitions–often made by expert panels including those with profession and financial conflict of interest–that label an ever-increasing pool of people as unwell.
To learn more about Consumer Reports’ work on overdiagnosis and overtreatment, visit Consumer Health Choices here.