Speculative Diversion: Overdiagnosis and Overtreatment


This page has been created to explore the concept, and the “dangers”, of over-diagnosis and over-treatment; which are thought by some to be prevalent in high income countries.

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Moynihan, R. Henry, D. [and] Moons, KG. (2014). Using evidence to combat overdiagnosis and overtreatment: evaluating treatments, tests, and disease definitions in the time of too much. PLOS Medicine. July 1st 2014; 11(7): e1001655.

A recent JAMA Internal Medicine article found that up to 42% of Medicare patients had received at least one “low-value” medical procedure, fueling the view that wasteful practices may be pervasive in the US health care system.

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Schwartz, AL. Landon, BE. [and] Elshaug, AG. [et al] (2014). Measuring low-value care in Medicare. JAMA Internal Medicine. July 1st 2014, Vol.174(7), pp.1067-76. (Click here to view the PubMed abstract).

Another recent American study found that most nursing home residents with advanced dementia receive medications with questionable benefit and incur substantial associated costs for the privilege.

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Tjia, J. Briesacher, BA. [and] Peterson, D. [et al] (2014). Use of Medications of Questionable Benefit in Advanced Dementia. JAMA Internal Medicine. September 8th 2014. [Epub ahead of print]. (Click here to view the PubMed abstract).

Responsibility to Make Best Use of NHS Funding

A report from the Academy of Medical Royal Colleges has estimated that 20% of clinical practice may have little or no benefit to patients. It reports a widespread overuse of tests and interventions. Other areas of potential savings are indicated:

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Maughan, D. [and] Ansell, J. (2014). Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care. London: Academy of Medical Royal Colleges, November 6th 2014.

On the Trends Towards the Medicalisation of All Ills

Unconnected examples of questions concerning the “a pill for every ill” debate:

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Pym, H. (2014). Another day, another tablet? London: BBC Health News, October 3rd 2014.

Possibly also of interest:

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Dowrick, C. [and] Frances, A. (2013). Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit. BMJ (Clinical research ed.). December 9th 2013, 347, f7140. (Click here to view the PubMed record).

Half of women and 43% of men in England take prescription drugs regularly, according to the Health Survey for England report from the Health and Social Care Information Centre (HSCIC). On average there were 18.7 prescriptions per person in England during 2013, costing the NHS over £15 billion per year. Sensible precautionary medicines intended to avoid unnecessary illnesses, such as those for blood pressure reduction and cholesterol-lowering statins, but also pain relief medicines and antidepressants, are the most commonly prescribed.

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Gallagher, J. (2014). Nearly 50% take prescription drugs. London: BBC Health News, December 10th 2014.

See also:

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Pym, H. (2014). A pill for every ill? London: BBC Health News, December 10th 2014.

A Selection of Older Articles

Some broadly-related articles on over-medicalisation (most recent first):

Clark, J. (2014). Do the solutions for global health lie in healthcare? BMJ. September 24th 2014; 349: g5457.

Melzer, D. Tavakoly, B. Winder, RE. [et al] (2014). Much more medicine for the oldest old: trends in UK electronic clinical records. Age and Ageing. August 7th 2014. [Epub ahead of print]. Full Text Link.

Pickersgill, MD. (2014). Debating DSM-5: diagnosis and the sociology of critique. Journal of Medical Ethics. August 2014; 40(8): 521-5. Full Text Link.

Norman, AH. Russell, AJ. Macnaughton, J. (2014). The payment for performance model and its influence on British general practitioners’ principles and practice. Cadernos de Saúde Pública. January 2014; 30(1): 55-67. Full Text Link.

Doust, J. Glasziou, P. (2014). Is the problem that everything is a diagnosis? Australian Family Physician. December 2013; 42(12): 856-9. Full Text Link.

Nunes, J. Ventura, T. Encarnação, R. [et al] (2013). What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study. Mental Health in Family Medicine. June 2013; 10(2): 67-79. Full Text Link.

Moscrop, A. (2014). Medicalisation, morality, and addiction: why we should be wary of problem gamblers in primary care. The British Journal of General Practice: the Journal of the Royal College of General Practitioners. December 2011; 61(593): e836-8. Full Text Link.

Shankar, PR. Subish, P. (2007). Disease mongering. Singapore Medical Journal. April 2007; 48(4): 275-80. Review. Full Text Link.

Fredriksen, S. (2006). Tragedy, utopia and medical progress. Journal of Medical Ethics. August 2006; 32(8): 450-3. Full Text Link.

Wessely, S. (2002). What do you think is a non-disease? Pros and cons of medicalisation. BMJ. April 13th 2002; 324(7342): 912. Full Text Link.

Clark, D. (2002). Between hope and acceptance: the medicalisation of dying. BMJ. April 13th 2002; 324(7342): 905-7. Full Text Link.

Johanson, R. Newburn, M. Macfarlane, A. (2002). Has the medicalisation of childbirth gone too far? BMJ. April 13th 2002; 324(7342): 892-5. Full Text Link.

Leibovici, L. Lièvre, M. (2002). Medicalisation: peering from inside medicine. BMJ. April 13th 2002; 324(7342): 866. Full Text Link.

Freemantle, N. Hill, S. (2002). Medicalisation, limits to medicine, or never enough money to go around? BMJ. April 13th 2002; 324(7342): 864-5. Full Text Link.

Ebrahim, S. (2002). The medicalisation of old age. BMJ. April 13th 2002; 324(7342): 861-3. Full Text Link.

Moynihan, R. Smith, R. (2002). Too much medicine? BMJ. April 13th 2002; 324(7342): 859-60. Full Text Link.

Note: The journal JAMA Internal Medicine has an interesting “Less is More” thread of articles.

More From the Academy of Medical Royal Colleges on Reducing the Harms of “Too Much Medicine”

The “Choosing Wisely” campaign (imported from the USA) suggests that medical organisations could each try to identify five interventions which perhaps should not be offered routinely (or possibly never provided).

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Malhotra, A. Maughan, D. [and] Ansell, J. [et al] (2015). Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine. BMJ. May 12th 2015; 350: h2308.

The following MedPage Today discussion concerns the “Choosing Wisely” movement and the “less is more” philosophy in the United States. The aim is to reduce the overuse of low-value (although often high-cost) services which are unlikely to help patients but carry risks of harm.

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Stephenson, J. (2015). ‘Less Is More’: The Next Big Thing for Medicine. If the doctor just says no, what does the patient hear? MedPage Today, May 26th 2015.

Possibly also of incidental interest:

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Carroll, A. (2015). Doing more for patients often does no good. The Incidental Economist. January 14th 2015.

“Choosing Wisely”-related articles from 2014:

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Must-Read Choosing Wisely Articles of 2014. United States [Online]: Choosing Wisely, January 15th 2015.

Antimicrobial Stewardship and Averting the Antibiotic Apocalypse

It is estimated that 10 million prescriptions for antibiotics in the UK per year may be inappropriate.

Public Health Information Requirement: On the Risks of Overdiagnosis Associated with Screening and Diagnostic Tests?

A recent survey of Australians concerning their understanding of what the term “Overdiagnosis” might mean found that nobody identified this construct as being associated with screening risk:

“Forty per cent of respondents thought overdiagnosis meant exaggerating a condition that was there, diagnosing something that was not there or too much diagnosis. Twenty-four per cent described overdiagnosis as overprescribing, overtesting or overtreatment. Only 3% considered overdiagnosis meant doctors gained financially. No respondents mentioned screening in conjunction with overdiagnosis, and over 10% of participants were unable to give an answer”.

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Moynihan, R. Nickel, B. [and] Hersch, J. [et al] (2015). What do you think overdiagnosis means? A qualitative analysis of responses from a national community survey of Australians. BMJ Open. May 19th 2015, Vol.5(5), e007436. (Click here to view the PubMed abstract).

More on the BMJ’s Too Much Medicine Campaign

“The BMJ’s Too Much Medicine campaign aims to highlight the threat to human health posed by overdiagnosis and the waste of resources on unnecessary care”.

Click here to view recent articles relating to the BMJ’s “Too Much Medicine” campaign.

King’s Fund: Better Value in the NHS

The King’s Fund “Better value in the NHS: the role of changes in clinical practice” report includes interesting sections on overuse and misuse.

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Alderwick, H. Robertson, R. [and] Appleby, J. (2015). Better value in the NHS: the role of changes in clinical practice. London: King’s Fund, July 8th 2015.

There is also an Executive Summary.

Savings Achievable By Reducing Low-Value General Surgical Interventions

A systematic review identified 71 low-value general surgical procedures. It is estimated that discontinuing five high-volume, high-cost general surgical procedures could save the NHS €153 million per year.

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).


Malik, HT. Marti, J. [and] Darzi, A. [et al] (2017). Savings from reducing low-value general surgical interventions. British Journal of Surgery. November 8th 2017. [Epub ahead of print].

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