I am writing this while en route to Sydney for a symposium celebrating the centenary of The Medical Journal of Australia where we will be talking about the history and future of medical publishing (follow the discussions at #MJA100).
Given that controversies in medical publishing will be up for discussion, no doubt we will be hearing about the role of researchers, institutions, medical journals, corporates and, yes, journalists in contributing to the “modern epidemic” of overdiagnosis in high-income countries.
In an article just published by PLOS Medicine, Ray Moynihan and colleagues suggest some solutions to the problems of overdiagnosis (while also acknowledging the problems of underdiagnosis and undertreatment).
These are summarised at the bottom of this post, but Croakey also recommends taking time out to watch this engaging clip below promoting the Choosing Wisely campaign (where is Australia’s version of this campaign?).
Apart from being a great example of engaging communications, it may lift your day, and put a spring and a sway to your step.
If you enjoyed that, check out some of the other health-promoting clips from James McCormack.
Meanwhile, back to PLOS Medicine: Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much
Summary of Suggestions for Improving the Evidence Base to Combat Overdiagnosis and Related Overtreatment
- Routine consideration of overdiagnosis and related overtreatment in the introduction and discussion sections of primary studies and systematic review articles about tests and treatments
- More condition-specific studies and reviews on the risk of overdiagnosis and related overtreatment—e.g., diagnosis of pulmonary embolism
- More rigorous routine evaluation of potential harms of treatments, tests, and changes to disease definitions
- In studies and reviews of studies of therapies, clearer stratification by baseline risk, to better identify treatment thresholds where benefits are likely to outweigh harms
- In studies and reviews of studies of test accuracy, more clarity about which target condition or spectrum of a disease is being considered, with a shift from a dichotomous “disease/no disease” frame to a “spectrum of disease severity” frame, and a linking of test accuracy to consequences for treatment and patient outcomes
- Panels that review and change disease definitions that are free of conflicts, and routinely consider evidence for potential harms as well as potential benefits of the changes they propose.