Friday, March 8, 2013
Over the past several decades, there has been a growing enthusiasm for early diagnosis - engaging many physicians in a systematic search for abnormalities in people who are well. Partly as a result, diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes, and even cancer, have skyrocketed over the last few decades. Yet many of the individuals given these diagnoses never develop the symptoms from their conditions. They are overdiagnosed. And, while overdiagnosed patients cannot benefit from treatments for these conditions - there is nothing to treat - the treatments themselves can be harmful to them. Because of this it is critical to understand the trade-offs between diagnosis and over-treatment, and to be sure that health care systems don't narrow the definition of normal so that - ironically - people are needlessly turned into patients and subjected to treatments that do harm instead of good.
The lecture will discuss the definition of overdiagnosis - the detection of an "abnormality" that would have otherwise never become evident during an individual's lifetime. It will describe the proximate mechanisms for overdiagnosis in current medical practice, such as changing rules, seeing more, looking harder, and tumbling onto things. It will explore the evidence for overdiagnosis and its harms. And it will consider approaches to mitigate the problem.