International Journal of Health Policy and Management

International Journal of Health Policy and Management

Overdiagnosis: An Important Issue That Demands Rigour and Precision; Comment on “Medicalisation and Overdiagnosis: What Society Does to Medicine”

Document Type : Commentary

Author
Stacy M. Carter
Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
10.15171/ijhpm.2017.24
Abstract
Van Dijk and colleagues present three cases to illustrate and discuss the relationship between medicalisation and overdiagnosis. In this commentary, I consider each of the case studies in turn, and in doing so emphasise two main points. The first is that it is not possible to assess whether overdiagnosis is occurring based solely on incidence rates: it is necessary also to have data about the benefits and harms that are produced by diagnosis. The second is that much is at stake in discussions of overdiagnosis in particular, and that it is critical that work in this area is conceptually rigorous, well-reasoned, and empirically sound. van Dijk and colleagues remind us that overdiagnosis and medicalisation are not just matters for individual patients and their clinicians: they also concern health systems, and society and citizens more broadly.
Keywords
Overdiagnosis
Medicalisation
Overtreatment
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. Morrison M. Overdiagnosis, medicalisation and social justice. J Med Ethics. 2016;42:720-721. doi:10.1136/medethics-2016-103717
  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. Conrad P. Medicalization and social control. Ann Rev Sociol. 1992;18(1):209-232. doi:10.1146/annurev.so.18.080192.001233
  5. Rose N. Beyond medicalisation. Lancet. 2007;369(9562):700-702. doi:10.1016/S0140-6736(07)60319-5
  6. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502. doi:10.1136/bmj.e3502
  7. Carter JL, Coletti RJ, Harris RP. Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods. BMJ. 2015;350:g7773. Doi:10.1136/bmj.g7773
  8. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605-613. doi:10.1093/jnci/djq099
  9. Rogers WA, Mintzker Y. Getting clearer on overdiagnosis. J Eval Clin Pract. 2016;22(4):580-587. doi:10.1111/jep.12556
  10. Rogers W, Mintzker Y. Casting the net too wide on overdiagnosis: benefits, burdens and non-harmful disease. J Med Ethics. 2016;42:717-719. doi:10.1136/medethics-2016-103715
  11. 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.
  12. Hofmann B. Defining and evaluating overdiagnosis. J Med Ethics. 2016;42:715-716. doi:10.1136/medethics-2016-103716
  13. Carter SM, Doust J, Degeling C, Barratt A. A definition and ethical evaluation of overdiagnosis: response to commentaries. J Med Ethics. 2016;42:722-724. doi:10.1136/medethics-2016-103822
  14. Carter SM, Degeling C, Doust J, Barratt A. A definition and ethical evaluation of overdiagnosis. J Med Ethics. 2016;42(11):705-714. doi:10.1136/medethics-2015-102928
  15. Marcus PM, Prorok PC, Miller AB, DeVoto EJ, Kramer BS. Conceptualizing overdiagnosis in cancer screening. J Natl Cancer Inst. 2015;107(4):djv014. doi:10.1093/jnci/djv014
  16. Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A. The challenge of overdiagnosis begins with its definition. BMJ. 2015;350:h869. doi:10.1136/bmj.h869.
  17. Murphy D. Concepts of Disease and Health. In: The Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/health-disease/. Published 2015.
  18. Jutel A, Nettleton S. Towards a sociology of diagnosis: reflections and opportunities. Soc Sci Med. 2011;73(6):793-800. doi:10.1016/j.socscimed.2011.07.014
  19. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012;380(9855):1778-1786. doi:10.1016/S0140-6736(12)61611-0
  20. Parker LM, Rychetnik L, Carter S. Framing overdiagnosis in breast screening: a qualitative study with Australian experts. BMC Cancer. 2015;15(1):1-8. doi:10.1186/s12885-015-1603-4
  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
  22. Carulla LS, Reed GM, Vaez-Azizi LM, et al. Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD-11. World Psychiatry. 2011;10(3):175-180.
International Journal of Health Policy and Management
Volume 6, Issue 10
2017
Pages 611-613

  • Received Date 20 January 2017
  • Revised Date 16 February 2017
  • Accepted Date 18 February 2017
  • First Published Date 01 October 2017
  • Published Date 01 October 2017