On the Social Construction of Overdiagnosis; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”

Document Type: Commentary

Author

1 Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway

2 The Centre for Medical Ethics, University of Oslo, Oslo, Norway

Abstract

In an interesting article Wieteke van Dijk and colleagues argue that societal developments and values influence the practice of medicine, and thus can result in both medicalisation and overdiagnosis. They provide a convincing argument that overdiagnosis emerges in a social context and that it has socially constructed implications. However, they fail to show that overdiagnosis per se is socially constructed and how this construction occurs. Moreover, the authors discuss overdiagnosis on a micro level without acknowledging that overdiagnosis cannot be observed in individuals “in the doctor’s office.” We cannot tell whether a diagnosed person is overdiagnosed or not. This is the core of the problem. Despite these shortcomings, Wieteke van Dijk and her colleagues are certainly on to something important, and they should be encouraged to elaborate their perspective. We certainly need to deepen our understanding of the social construction of overdiagnosis.

Keywords

Main Subjects


  1. van Dijk W, Faber MJ, Tanke MA, Jeurissen PP, Westert GP. Medicalisation and overdiagnosis: what society does to medicine. Int  J Health Policy Manag. 2016;5(11):619-622. doi:10.15171/ijhpm.2016.121
  2. Hofmann B. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. Eur J Epidemiol. 2014;29(9):599-604. doi:10.1007/s10654-014-9920-5
  3. Hofmann B. Medicalization and overdiagnosis: different but alike. Med Health Care Philos. 2016;19(2):253-264. doi:10.1007/s11019-016-9693-6
  4. Hofmann B. Defining and evaluating overdiagnosis. J Med Ethics. 2016;42(11):715-716. doi:10.1136/medethics-2016-103716
  5. Hofmann BM. Conceptual overdiagnosis. A comment on Wendy Rogers and Yishai Mintzker's article "Getting clearer on overdiagnosis." J Eval Clin Pract. 2016. doi:10.1111/jep.12652
  6. Brodersen J, Schwartz LM, Woloshin S. Overdiagnosis: how cancer screening can turn indolent pathology into illness. APMIS. 2014;122(8):683-689. doi:10.1111/apm.12278
  7. Mukherjee S. The Emperor of All Maladies: A Biography of Cancer. New York: Simon and Schuster; 2010.
  8. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605-613.
  9. Raffle A, Muir Gray J. Screening: Evidence and Practice. New York, NY: Oxford University Press; 2007.
  10. Carter SM, Degeling C, Doust J, Barratt A. A definition and ethical evaluation of overdiagnosis. J  Med Ethics. 2016. doi:10.1136/medethics-2015-102928
  11. Welch HG, Black WC. Using autopsy series to estimate the disease "reservoir" for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997;127(11):1023-1028.
  12. Hofmann B. Too much technology. BMJ. 2015;350:h705doi:10.1136/bmj.h705