EXPANDING definitions of disease are leading to over diagnosis and unnecessary treatment, and pose a major threat to human health and the sustainability of health systems, according to a paper published in BMJ Evidence-Based Medicine.
The authors cite evidence suggesting that specialist guideline groups which regularly review disease definitions often decide to expand them by lowering thresholds to capture more people at lower risk of future illness and by creating pre-diseases. There can also be a tendency to overmedicalise common or mild life experiences or to change diagnostic processes.
The authors contend this is leading to overdiagnosis and overtreatment, and that the specialist panels proposing these expansions are often conflicted and do not investigate potential harms.
Examples cited include the widely used definition of chronic kidney disease, which could apply to around half of all older people although many will never experience related symptoms, and a "new definition of hypertension which labels one in every two adults" and has been "soundly rejected by family doctors over concerns it may cause more harm than good to many people".
The paper is calling for new ways to define disease in order to reduce overdiagnosis. Such processes would involve using "explicit guidance to assess potential benefits and harms when modifying disease definitions, with a focus on people-centred outcomes". Decision panels should also be "primary-care led, multidisciplinary, with representation from civil society and independent from financial ties to industry".
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, commented: "Disease mongering is scaremongering and it has the potential to cause huge strain for the NHS and other healthcare systems around the world.
"Giving people unnecessary medical labels causes anxiety and distress and, in the worst cases, causes harm that can ruin lives. It also leads to unnecessary workload burdens in general practice and secondary care, and consumes funding that could be much better spent elsewhere on the care of patients who really need it.
"This is a controversial but ground-breaking paper that should spark a widespread debate on the entire industry that has grown up around disease mongering and overdiagnosis."
Link: Reforming disease definitions: a new primary care led, people-centred approach
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