Jump to comment:

• Practices of no net benefit
  Jack W O'Sullivan
  Published on: 19 May 2016

• Published on: 19 May 2016

  Practices of no net benefit

  • Jack W O'Sullivan, Doctor and DPhil Candidate
  • Other Contributors:
    • Dr. Jeffrey Aronson

  The phenomenon of "overdiagnosis" is currently attracting the interest of health professionals, researchers, and governments. However, Ghanuouni and colleagues suggest that the definition of the phenomenon is not clearly understood. A major problem with the term is that it is imprecise. This is reflected by the public's varying attempts to define overdiagnosis: their responses spanned four themes and 15 subthemes. Howev...

  Show More

  The phenomenon of "overdiagnosis" is currently attracting the interest of health professionals, researchers, and governments. However, Ghanuouni and colleagues suggest that the definition of the phenomenon is not clearly understood. A major problem with the term is that it is imprecise. This is reflected by the public's varying attempts to define overdiagnosis: their responses spanned four themes and 15 subthemes. However, we believe that the term itself is inappropriate and misleading.

  The definition of "overdiagnosis" used by the authors, "the diagnosis of disease which would never have become clinically apparent in a person's lifetime (i.e. causing neither symptoms nor death)", is currently largely accepted. However, as the authors acknowledge, this definition and the term itself both emphasise the possible harms of a diagnosis.

  A diagnosis in isolation might cause a patient distress or other psychological harm, but the potential for physical harm and waste of finite resources occurs through inappropriate testing, which reveals the diagnosis, and inappropriate treatment of diagnoses that do not need it. An inappropriate test can harm a patient through a direct adverse reaction (e.g. contrast nephropathy) or harm indirectly, by diverting resources from necessary interventions. Inappropriate treatment can cause harm by the same mechanisms and by medicalizing the patient.

  Focusing on the term "overdiagnosis" distracts from the two activities that can cause patient harm and waste resources: testing and treating. We prefer the term 'practices of no net benefit'. "Practices" refers to medical practices (tests or treatments) and "no net benefit" implies that the tests or treatments may result in some benefits, but their harms outweigh those benefits. Identifying and reducing practices of no net benefit will prevent the diagnosis of diseases that might never become clinically apparent and reduce the frequency with which net harmful treatments are offered to patients.

  Some of the subjects in the study reported by Ghanuouni and colleagues - those who defined "overdiagnosis" as "too many tests" or "overtreatment" - seem to have understood this. Perhaps the public are more aware of the problems than they are given credit for.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top