OVERDIAGNOSIS

It's was refreshing to read something this morning from the Medical Mafia, reported in the Brisbane Times, that makes some sense. It came from Australia's Chief Medical Officer Professor Brendan Murphy who said about overdiagnosis in the medical profession:

(it is) "a significant issue in all countries with advanced health systems. We know harm can come from overdiagnosis,” Professor Murphy said, from causing undue anxiety and labelling people with stigmatising disorders, to serious adverse effects from unnecessary aggressive or invasive treatments. There is no doubt we need some sort of approach to address it.

The Brisbane Times article goes on to say that:

Overdiagnosis is exposing healthy people to tests and treatments that are at best useless, and at worst trigger aggressive procedures with devastating side effects, a formidable alliance of peak doctors colleges, researchers, advocates and public health experts warned. 

The alliance - forged by the Wiser Healthcare research collaboration - is developing a world-first national action plan to curb overdiagnosis across the medical spectrum, from Attention Deficit Hyperactivity Disorder (ADHD) to cancer. Reversing the harms of too much medicine was becoming a healthcare priority, members of the emerging alliance wrote in the Medical Journal of Australia on Monday.

The Wiser Healthcare collaboration states that:

Wiser Healthcare is a research collaboration involving The University of Sydney, Bond University, Monash University and international colleagues. We investigate the cause and size of the problem and test new solutions, in the areas of cancer, cardiovascular disease and musculoskeletal disorders, with a particular focus on overdiagnosis caused by imaging (like CT scans and MRI scans), testing biomarkers (for example, blood tests like the Prostate Specific Antigen test), and genetic tests. Here you can find out about our plans, read our work, see the evidence about overdiagnosis, and get help to make decisions, whether you are a clinician, policymaker, or citizen considering your own healthcare.

There's clearly no plans to address the scourge of vaccinations but at least it's a start. What it will achieve actually however, remains to be seen. At least the issue is being discussed and advice given to prospective victims of overdiagnosis. Here is some advice that is offered:

Keeping it short 

Short questions that have been shown to improve the quality of information that doctors provide about treatment options: 

What are my options?
What are the possible benefits and harms of those options?
How likely are each of those benefits and harms to happen to me?
What will happen if I do nothing? 

Choosing Wisely 

Questions recommended by the Choosing Wisely organisation in Australia, to help avoid unnecessary tests and treatments: 

Do I really need this test, treatment or procedure?
What are the risks?
Are there simpler, safer options?
What happens if I don’t do anything?
What are the costs?

The Choosing Wisely organisation professes to be helping healthcare providers and consumers start important conversations about improving the quality of healthcare by eliminating unnecessary and sometimes harmful tests, treatments, and procedures. It is facilitated by NPS MEDICINEWISE that purports to be making Australia more medicinewise, through digital health and data insights, health professional education and reliable health information for consumers.

The authors of the MJA Perspective wrote:

Cultural beliefs that more tests and treatments were always better, financial incentives to diagnose and treat in the health system and increasingly sensitive diagnostic technologies detecting minor abnormalities were likely major drivers of overdiagnosis. 

Doctors’ cognitive biases and the fears that they might miss something, coupled with the public’s expectation that the clinicians should “do something” also fed overdiagnosis.

Of course, there will be immediate reactions from those medical areas that feel threatened:

Chief executive of Cancer Council Australia Sanchia Aranda said any moves to curb overdiagnosis must not undermine national screening programs and the benefits of early detection. 

 Here is the link to the MJA article and also a link to some information about Alan Cassels (his website at www.alancassels.com doesn't seem to be working). This is some information taken from the footnotes to a YouTube video which I just watched and which I've embedded below:

Alan Cassels has been immersed in pharmaceutical policy research and healthcare journalism for the past 23 years, mostly studying and writing about how prescription drugs are regulated, marketed, prescribed and used. His niche is in exposing the large gap between the marketing and the science around prescription drugs, medical screening and other forms of disease creation. His books include Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us All into Patients (co-written with Ray Moynihan), The ABCs of Disease Mongering: An Epidemic in 26 Letters, and Seeking Sickness: Medical Screening and the Misguided Hunt for Disease.