Influential groups of Australian clinicians, consumers and policy makers have launched a call to action to address the problems of overdiagnosis and related overtreatment.
This launch follows a National Summit on Overdiagnosis, hosted by the Wiser Healthcare research collaboration at the University of Sydney, and attended by almost 60 representatives of leading stakeholders and researchers.
Overdiagnosis happens when people are diagnosed with conditions that would not harm them, leading to unnecessary treatments that can cause more harm than good. One example is thyroid cancer, with evidence many people are diagnosed and treated unnecessarily for very small tumours that are in fact benign.
The statement was developed over the past 12 months – but publicly released for the first time: “Alongside the undisputed ability of healthcare to extend human life and ameliorate suffering” says the statement, “there is growing evidence and concern about the problem of too much medicine.”
“Overdiagnosis and the related overuse of medical tests and treatments not only causes harm, but also divert resources from addressing underdiagnosis and undertreatment.”
Development of the statement was facilitated by the NHMRC-funded Wiser Healthcare research collaboration and has been initially endorsed by five leading health organisations including the Consumers Health Forum (CHF), The Royal Australasian College of Physicians (RACP), the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Commission on Safety and Quality in Healthcare (ACSQHC).
“This is the first coordinated national effort to address a problem now recognised worldwide as a significant threat to healthcare,” says Professor Kirsten McCaffery, from University of Sydney, and a member of the Wiser Healthcare team.
The statement notes that a key driver of the problem of overdiagnosis is expanding disease definitions and lowering diagnostic thresholds which label more previously healthy people as sick. A series in the leading medical journal The British Medical Journal has raised concerns about this problem across a range of conditions including pulmonary embolism, attention deficit hyperactivity disorder, chronic kidney disease, depression, high blood pressure and osteoporosis.
Another driver is the increasing sophistication of imaging tests that pick up abnormalities that are just as common in people with and without symptoms, but may be mistakenly interpreted as something that needs to be treated, for example in people with back pain.
The Australian plan echoes action in other nations, arising from growing scientific evidence of the problem shared at the international Preventing Overdiagnosis conferences being held in Quebec City.
“The problem of too much medicine is driven by many factors – including the best of intentions” says Dr Ray Moynihan, from Bond University and a member of the Wiser Healthcare collaboration.
“But there is now a growing global consensus to start addressing the problem of too many unneeded tests, treatments and diagnoses, which not only threaten human health, but also health system sustainability.”