Overtreatment backlash grows

A GROWING international backlash against overtreatment is gathering pace, with a movement led by prominent doctors seeking to mobilise the medical community to stop possible harms to patients.

A feature article in the BMJ reports that the movement is challenging the assumption that more health care is better. (1)

Although the issue had been bubbling in the background for decades, technological advances in medicine had forced it onto the mainstream medical agenda, according to Australian evidence-based medicine expert, Professor Paul Glasziou, from Bond University.

Professor Glasziou is on the steering committee for next year’s Preventing Overdiagnosis conference, which will be hosted by Dartmouth Institute for Health Policy and Clinical Practice in the US in partnership with Queensland’s Bond University, the BMJ, and New York-based consumer organisation Consumer Reports.

“This is not sudden, it has been building momentum over time, but better diagnostic tools have been a key trigger”, Professor Glasziou said.

“Overdiagnosis wasn’t a problem 100 years ago as we didn’t have the technology to do that”, he said. Changing definitions of disease were also leading to overdiagnosis that resulted in unnecessary procedures, treatments and worry.

“There has been this gradual increase over time and we’ve reached a critical point as we can now classify everybody as having some sort of illness”, he said.

Preventing Overdiagnosis would be a scientific conference bringing together doctors thinking about different parts of the problem, with the aim of building a better awareness of the broader issues.

“We want to understand the problem better so we can work out how to turn this ship around”, Professor Glasziou said.

“If we can rein it in, we will have more resources to treat those people who need it and stop harming those who don’t”, he said.

The BMJ article reported on the Avoiding Avoidable Care conference held in April this year, described as the first conference held in the US to focus exclusively on overtreatment.

The article said the conference attracted a “who’s who of American medicine”, who provided examples of unnecessary care in many areas of medicine including the use of screening tests, surgery and imaging technology, and at the end of life.

Speakers also identified multiple causes of overtreatment, including malpractice fears, supply-driven demand, knowledge gaps, biased research, profit seeking, patient demand and financial conflicts of clinical practice guideline writers.

One speaker said that medical students “were taught to do things, not how to know what not to do”, the article said

There was general agreement on some solutions to the problem, such as using experts free of conflicts of interest to write guidelines, implementing shared decision making, reducing excess hospital capacity, and reforming tort law.

- Amanda Bryan

1. BMJ 2012; Online 2 October

Posted 8 October 2012

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