BMJ: Overdiagnosis - a driver of too much medicine

3 December, 2018

CITATION: Brodersen J et al. Overdiagnosis: a driver of too much medicine

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3494

https://www.bmj.com/content/362/bmj.k3494

'Ironically, even though it causes harm, the effects of overdiagnosis look like benefits. People with disease that is overdiagnosed do well because, by definition, their disease was non-progressive. They are “cured” when cure was not necessary in the first place. This creates a cycle that reinforces efforts leading to more overdiagnosis. A screening test that results in substantial overdiagnosis improves survival statistics by diluting the diagnosed pool with many non-progressive cases, which makes screening seem more effective than it is. The spurious rise in incidence makes the case for screening more compelling, thus heightening people’s sense of risk—a phenomenon known as the popularity paradox.'

The popularity paradox is described in Angela Raffle and Muir Gray's book, Screening: Evidence and Practice (2007).

I suspect that awareness of the phenomenon is very low even among health professionals, let alone patients.

The authors of this editorial note: 'Efforts to engage journalists about overdiaghnosis could also help dampen unrealistic expectations about screening.'

Best wishes, Neil

Coordinator, HIFA Project on Evidence-Informed Policy and Practice

http://www.hifa.org/projects/evidence-informed-policy-and-practice

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 18,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG /orcid.org/0000-0001-9557-1487 neil@hifa.org