Reforming disease definitions: a new primary care led, people-centred approach

Abstract

Expanding disease definitions are causing more and more previously healthy people to be labelled as diseased, contributing to the problem of overdiagnosis and related overtreatment. Often the specialist guideline panels which expand definitions have close tis to industry and do not investigate the harms of defining more people as sick. Responding to growing calls to address these problems, an international group of leading researchers and clinicians is proposing a new way to set diagnostic thresholds and mark the boundaries of condition definitions, to try to tackle a key driver of overdiagnosis and overtreatment. The group proposes new evidence-informed principles, with new process and new people constituting new multidisciplinary panels, free from financial conflicts of interest.

Financial ties between leaders of influential US professional medical associations and industry: cross sectional study

“…As one author observed, given their essential role in “maintaining and promoting the quality of medical care” and in order to show “independence and integrity,” leaders of professional medical associations must be “free of all financial ties with industry,” which he argued is feasible 8. As others have observed, guidelines from these professional medical associations “frequently call for greater use of health care services,” 21 and financial independence from commercial interests is doubly desirable if we are to tackle the problems of overuse and overdiagnosis 22. Although association board members rarely write their association guidelines, their leadership and influence guide the tone and approach for the entirety of their association’s work.…”

New hypertension guidance risks overdiagnosis and overtreatment

“…To help change this discourse, diagnostic thresholds and the boundaries of disease should be defined not by disease specialists but by financially independent, people centred panels that are led by primary care12 and include research methodologists, experts in critical appraisal, healthcare consumers, and health economists.…”

Cochrane Sustainable Healthcare: evidence for action on too much medicine

“…Much work is already underway to identify medical excess and mitigate its harmful consequences. This includes: e orts to improve the trustworthiness of the evidence base through transparency and independence from commercial influence; [11] [12] explicit considerations of benefits, harms, costs, and burdens when making clinical guideline recommendations; [13] campaigns to de-implement or deintensify low-value care; [14] initiatives to tackle the problem of inappropriately expanding disease definitions; [15] and participatory approaches to the development of care plans that are evidence-informed, responsive to problematic situations of patients, and minimally disruptive. [6] Generally, such e orts focus narrowly on particular manifestations of the problem rather than on broader considerations of the cultural, political, social, professional, scientific, and financial processes that encourage us to do something rather than nothing, even when it may do more harm than good.…”

“…14 Cochrane Portugal, Choosing Wisely Portugal, University of Lisbon, Portugal. 15 The Dartmouth Institute, USA. 16 Bond University, Australia…”