Overdiagnosis and an excessive amount of drugs in a world of crises

  1. Thomas Kühlein1,
  2. Helen Macdonald2,
  3. Barnett Kramer3,
  4. Minna Johansson4,
  5. Steven Woloshin45,
  6. Kirsten McCaffery6,
  7. John B. Brodersen7,
  8. Tessa Copp8,
  9. Karsten Juhl Jørgensen9,
  10. Anne Møller10,
  11. Martin Scherer11
  12. for the Scientific Committee of the Stopping Overdiagnosis Convention

  1. 1Institute of Common Follow, Universitätsklinikum Erlangen, Germany

  2. 2The BMJ, London, United Kingdom

  3. 3The Lisa Schwartz Basis for Reality in Drugs Norwich, VT/USA

  4. 4World Heart for Sustainable Healthcare, Gothenburg, Sweden

  5. 5Dartmouth Institute for Well being Coverage and Scientific Follow, Lebanon, NH/USA

  6. 6Sydney Well being Literacy Lab, Wiser Healthcare, School of Drugs and Well being, College of Public Well being, The College of Sydney, Sydney, NSW, Australia

  7. 7Centre of Analysis & Training in Common Follow, Division of Public Well being, School of Well being Sciences, College of Copenhagen; Major Well being Care Analysis Unit, Area Zealand and Analysis Unit for Common Follow, Division of Neighborhood Drugs, School of Well being Sciences, UiT The Arctic College of Norway, Tromsø Odense College Hospital Odense, Denmark and Cochrane Collaboration, Oxford, United Kingdom

  8. 8Wiser Healthcare, School of Drugs and Well being, College of Public Well being, The College of Sydney, Sydney, NSW, Australia

  9. 9Herrestads Healthcare Centre, Närhälsan, Denmark; World Heart for Sustainable Healthcare, Gothenburg Denmark; College, FoUUI Fyrbodal, Cochrane Sweden

  10. 10Centre of Analysis & Training in Common Follow, Division of Public Well being, School of Well being Sciences, College of Copenhagen; Major Well being Care Analysis Unit, Area Zealand, Denmark

  11. 11Institut and Polyclinic of Common Follow, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany

  12. 12Stopping Overdiagnosis Convention.

Tackling overdiagnosis will create extra sustainable healthcare for folks and the planet

Many healthcare techniques are dealing with crises of extra demand, elevated prevalence of persistent illness, spiralling prices, and workforce challenges which threaten their functioning.12 Current proof means that a part of the rise in prevalence of “illness” is because of overdiagnosis, overtreatment, and total low worth care.3 It has been estimated that 30% of medical care is of low worth or wastes assets, and 10% is dangerous.4 The well being sector is estimated to account for greater than 5% of greenhouse fuel emissions in industrialised international locations—one other manner by which low worth care threatens well being.5

There’s a want for extra capability in healthcare, extra funding in healthcare, and extra staffing in some areas, and for specialties to enhance well being, wellbeing, and inequality. Nevertheless, the exponential enlargement of medical territory within the final half century has grow to be unsustainable, resulting in hovering healthcare prices, an unreasonable therapy burden for sufferers, burnout amongst healthcare employees, and substantial hurt to the planet. We’d like additional thought and dialogue in regards to the finite monetary, human, societal, and planetary assets accessible for healthcare and about higher distribution of current assets.

Present crises in healthcare supply are exacerbated by ageing populations and related multimorbidity. Coverage makers, politicians, and the general public want to know how even well-meaning efforts to offer extra and higher healthcare inevitably amplify and reinforce these crises by means of overdiagnosis, overmedicalisation, and overtreatment, diverting assets from more practical choices.6 These points should be resolved if we’re to attain sustainable healthcare.

Being open to the potential for extra healthcare, awaiting the indicators, and taking motion to cut back it, will assist be certain that all diagnostic labels are significant and that exams and coverings confer clinically related advantages. It is going to additionally assist choice makers to take a position their time and assets in excessive worth healthcare, somewhat than on unsure or dangerous screening, expertise, merchandise, or interventions.

Controlling extra healthcare

Lowering overdiagnosis is a crucial first step to controlling extra healthcare. Clinicians, thought leaders, and others who establish medical extra have an obligation to share their information and work to vary minds and practices. This work cuts throughout the entire of healthcare. For instance, strengthening major care in healthcare techniques can scale back overdiagnosis and improve continuity of care, whereas public well being is finest positioned to overview screening programmes.7 Messages regarding low-value care may be disseminated through conventional media, or extra informally through social media.

The idea of overdiagnosis must be taught as a part of proof based mostly healthcare from the early levels of medical coaching. Instructional alternatives and assets on overdiagnosis, proof based mostly healthcare, and demanding considering must also be provided to legislators, coverage makers, and their employees, in addition to sufferers and the general public. This instructing must be well timed, participating, compelling, and actionable. Challenges stay in speaking the dimensions of overdiagnosis and illustrating the human price, for instance by placing particular person faces and tales to summary ideas and information.8

The potential for overdiagnosis is ever current in healthcare and the neighborhood must publicise new examples as they come up. Established screening programmes must be re-evaluated following new developments corresponding to efficient major prevention, modifications in eligible populations, or the supply of higher therapies for symptomatic illness. For instance, because the prevalence of smoking decreases so do the incidences of ruptured belly aortic aneurism and lung most cancers; childhood HPV vaccinations are decreasing the incidence of cervical dysplasia and most cancers.910 Each have implications for the chance profit stability of screening programmes.

Companies and interventions which are redundant, low worth, or dangerous must be routinely recognized and decommissioned.

Our international medical tradition has pushed extreme diagnostic testing, overmedicalisation, and overtreatment throughout many situations that will hurt sufferers, exhaust healthcare assets, and hurt the planet.11 We name upon native, nationwide, and worldwide choice makers to extra prominently and overtly acknowledge these points and take pressing steps to resolve them. Solely then can we hope to create extra sustainable healthcare sooner or later.


  • Competing pursuits: All of the authors have learn and understood the BMJ coverage on declaration of pursuits and declare no competing pursuits besides being voluntary and unpaid members of the scientific committee of the Stopping Overdiagnosis Convention. This 12 months’s convention will likely be held from 14. to 16. August 2023 in Copenhagen, Denmark. https://www.cebm.ox.ac.uk/upcoming-events/preventing-overdiagnosis

  • Provenance and peer overview: commissioned, not peer reviewed.