Overdiagnosis poses significant threat to human health

[Celebration]

Over-Diagnosis

"The Dartmouth Institute for Health Policy and Clinical Practice has long been a leader in understanding and communicating the problems of overdiagnosis," say Drs. Steven Woloshin and Lisa Schwartz, professors of medicine at The Dartmouth Institute for Health Policy and Clinical Practice. "We are extremely excited to host this international conference to advance the science and develop concrete proposals to reduce overdiagnosis and its associated harms."

Overdiagnosis occurs when people are diagnosed and treated for conditions that will never cause them harm and there's growing evidence that this occurs for a wide range of conditions.

For example, a large Canadian study finds that almost a third of people diagnosed with asthma may not have the condition; a systematic review suggests up to one in three breast cancers detected through screenings may be overdiagnosed; and some researchers argue osteoporosis treatments may do more harm than good for women at very low risk of future fracture.

Many factors are driving overdiagnosis, including commercial and professional vested interests, legal incentives and cultural issues, say Moynihan and co-authors, Professors Jenny Doust and David Henry. Ever-more sensitive tests are detecting tiny "abnormalities" that will never progress, while widening disease definitions and lowering treatment thresholds mean people at ever lower risks receive permanent medical labels and life-long therapies that will fail to benefit many of them.

[Drale]

1. It also causes people to look down on those with disorders

I have ADHD and people tend to write it off but it really does affect my life especially in school.

[flamingdem]

2. I learned early that this is a HUGE problem

also watch out if you go to a specialist, funny how it's likely they'll see their favorite problem, the one they built their reputation on, in your body whether it's there or not.

Too much subjectivity leads to taking advantage, partially ego, partially profits are the motive.

[HuckleB]

7. Specialists can be narrowly focused, but...

... not so narrowly focused as your classic alt/cam practitioner. I'd like to see some research on the effect of scam care practitioners on "overdiagnosis."

[kestrel91316]

3. Insurance companies secretly LOVE this trend because

once you get diagnosed with ANY prior condition except for maybe a minor bladder infection or head cold, you are marked for life and can only purchase extremely expensive insurance.

Of course, that is all SUPPOSED to change with the health insurance reform that was passed, but I suspect it won't. The insurance companies WILL find a way to refuse policies to folks with pre-existing conditions. Likely they will require 500 questions be answered in minute detail, and when there is the slightest discrepancy with medical records, they will drop you and blacklist you for FRAUD.

[Ron Obvious]

4. Fee for service?

I wonder how these rates compare against countries that don't have our 'fee for service' model for healthcare? Or our propensity for lawsuits, I suppose.

[hedgehog]

5. I was dubious about the statement, but the Dartmouth Institute does seem

to be honestly studying how to produce the best outcomes rather than fronting for a think tank trying to ration care.

(This is from me, rather than from the link) For example, we need to find out if PSA tests are really worthwhile. Right now it is questionable. Would the aggressive cancers that need treatment also be found early enough by simple digital exam? Are we finding cancers that would never spread by using the PSA, and subjecting thousands of men to unneeded worry and/or unneeded drastic treatments? I have the same questions regarding breast cancers.

I'm curious about the specific reference to asthma over-diagnosis. The question i would have is whether everyone is using the same definition, and whether people who are being treated are benefitting regardless of diagnosis. For example, there are people in my family who can move a volume of air on peak flow that falls within normal limits. However, they also seem to have an inflammation of the lungs due to seasonal allergy that makes breathing difficult and that is relieved by inhaled steroids. So, is that asthma or not?

[HuckleB]

6. This is a worthy area of study.

Of course, it seems that at least some of the problem is the "alternative/supplement/scam" industry that sucks so many people into believing they have problem X, and that they can solve it by spend Y amount of money on BS.

Anyway, acknowledging that, seems like a small step toward solving such issues.

[trotsky]

8. I thought the same thing.

You want to talk about overdiagnosis - the supplement-pushers definitely need to be in that discussion along with unnecessary medical treatments.

[laconicsax]

9. +1

[Celebration]

10. public funds don't pay for supplements

They pay for unneccessary medical treatments. Individuals pay for their own supplements.

Medicare, Medicaid and high insurance rates are completely not affected by decisions people make as individuals on supplements.

Nor do supplements involve dangerous procedures such as operations.

[trotsky]

12. Do public funds pay for red herrings?

Overdiagnosis and unnecessary treatment is the issue here.

No different with supplements.

[Celebration]

14. why is overtreatment the issue?

$$$$--follow the money.

And, in the case of medical treatments such as prescription drugs and operations, these are sanctioned by supposedly trained health care professionals, licensed and partially paid by the state. Vitamins are generally a purchase that is basically a consumer choice, comparable to the choice of purchasing a soft drink.

This all has to do with evidence based medicine, which will be imposed on all of us in order to curtail health care costs. Hey it is a good idea, probably. But watch how a lot of women react when they can't get their yearly mammogram paid for at age 40, evidence or no.

None of the PTB care much about people wasting money on supplements. I know I don't, either. How people spend their own money, wasteful or not, is their business. Public funds, however, are everyone's business. I don't want to snoop into people's purchases, whether it be fructose filled soft drinks (obviously harmful and a waste of money), or vitamins (some wasteful, some helpful, could possibly be a waste of money).

One could make a decent argument that fructose filled soft drinks impact overall health, and indirectly affect health costs. Bloomberg has made that argument. His restriction doesn't ban them outright, and only minimally affect the size, so I am not opposed to it.

I would assert that if people want to dramatically affect public health, it is a much more useful pastime to rail against soft drinks rather than vitamins. And concentrate on the state sponsored overtreatment areas (as in Medicare, Medicaid, state licensed MDs)

[trotsky]

15. Follow the money, indeed.

http://www.nutraceuticalsworld.com/issues/2010-06/view_industry-news/u-s-herbal-supplement-sales-reach-5-billion/

All I'm asking is that we look at the ENTIRE problem. You want to ignore part of it.

[Celebration]

16. except...................it's not much of a problem

We can't and don't look over everyone's shoulder and make sure they don't waste money. That infringes on personal freedom when there is no compelling health reason for it. Government money is a different story!

People REALLY waste money on gym memberships, because many people buy a package, and then don't go. What would you do? Ban the sale of memberships for more than one month because so many people waste money? That's ridiculous.

[trotsky]

17. Again, allow me to return you to the subject of this thread:

Overdiagnosis and unnecessary treatment.

Gym memberships do not fall into that category. Supplements do.

Do you have any other red herrings you'd like to bring up, or are you done now?

[Celebration]

18. you must not have read it all

The harm of overdiagnosis to individuals and the cost to health systems is becoming ever clearer. Far less clear is what we should do about it. Next year's conference is an important step towards some evidence based solutions."

Neither of these is in play when people take an extra 500mg tablet of Vitamin C. There is no cost to health care systems and there is no proven harm to individuals. If it is proven harm to individuals that you are concerned about, you best be concerned with the proven harm of ingesting large amounts of high fructose corn syrup.

[trotsky]

19. You are 1) wrong and 2) doing a bait-n-switch.

Your bait & switch is going from talking about supplements in general to one specific dosage of one specific vitamin. This is dishonest and fallacious, and is therefore irrelevant.

You are wrong because supplements CAN harm, and they do cost money - not just to the consumer but to the health system that must treat them if they are harmed.

I do see that you answered my question in the affirmative, you DO have more red herrings. This time it was HFCS. Funny!

[Celebration]

20. Hardly

That was merely a very common example. The OP has nothing to do with vitamins. Taking vitamins has almost nothing to do with diagnosis at all. The concerns of overdiagnosis as articulated in the article are in no way applicable to an individual's vitamin purchases. Admittedly, if they were covered by govt. insurance programs, that would be a different story, although it would stll pale in comparison to the dollars spent on unnecessary operations.

The fact that vitamins aren't being discussed shows what a nonissue they are.

[trotsky]

21. Answer two simple questions.

1. Do at least some people take supplements (this is more than just vitamins, you know) that are unnecessary?

2. Do at least some supplements carry a risk due to overuse, misuse, or combination with another supplement or drug?

Please answer honestly (each is just a simple yes or no answer) and this discussion can continue. If you again change the subject or introduce another red herring, I will conclude that you concede the point, and the discussion is over.

Thanks so much!

[Celebration]

22. that's too easy

1. Just as people eat food that is unnecessary, people sometimes do overkill on supplements.

2. Sure! Kind of like grapefruit juice doesn't go with blood pressure medicine.

[trotsky]

23. Perfect.

You just made my case for why this should also apply to supplements. Thanks!

[Celebration]

24. Not at all

Unless you also think the government should also regulate the sale of grapefruit juice and, cookies, soft drinks.

[trotsky]

25. And red herrings, for sure! n/t

[SheilaT]

11. Overdiagnosis, overtreatment, overmedication are all

genuine problems. However, I notice that whenever these topics are brought up, especially in some specific way such as the recent recommendation against mammograms in women under age 40, all of a sudden people came screaming out of the woodwork and every single one swore that her life was saved by early and frequent mammograms.

I suspect that those who are overdiagnosed and so on, wind up with a vested interest in thinking they really are part of the small percent of those who needed the diagnosis and treatment.

I recently read the book "How We Do Harm" by Otis Webb Brawley, MD precisely about that problem.

[flamingdem]

13. Good point

Even if the surgery for breast cancer was unnecessary... some are because they retract by themselves ...but don't tell that to the convinced, worse to those who had surgery or saw others go through it..