Overdiagnosis

• In preparation for a national plan of response, a map of possible drivers of overdiagnosis and its potential solutions was developed by our team from the medical literature. Examples of the key drivers across the five interrelated domains include:
• Cultural beliefs that more tests and treatments are better,
• Financial incentives at the health system level,
• Technological change enabling identification of smaller and more minor abnormalities,
• Professional fear of missing disease and cognitive biases in decision making, and
• Public expectations that clinicians will "do something".

We know that often the people affected most by health policies and guidelines are not meaningfully consulted. When informed about the challenges of overdiagnosis and overtreatment, community members (those most directly affected by the health condition) may provide important and unique contributions to potential solutions. Our community engagement team researches methods to improve engagement and meaningful consultation with patients and the public through our deliberative democracy research.

New reform aims to prevent overdiagnosis and stop defining healthy people as diseased. Overdiagnosis can happen when the definitions of diseases are broadened so much that people with very mild problems, or people at very low risk of future illness, are classified as being sick, given a label, and then offered treatments which may do more harm than good.

Examples of the problem of inappropriately expanded definitions of disease include:

• The controversial definition of Chronic Kidney Disease, which labels many older people who will never experience related symptoms, was launched at a meeting sponsored by a drug company
• A vastly expanded definition of Gestational Diabetes, which may now label up to one in five pregnant women, despite a lack of good evidence that the newly labelled women or their babies will gain meaningful benefits that outweigh potential harms
• A proposal to expand the definition of High Blood Pressure, which would label one in every two adults in the US, but has been rejected by a family doctor organisation and others over concerns it may cause more harm than good to many people
• The creation of “pre-diseases” such as pre-osteoporosis, or pre-diabetes, which classify healthy people who are essentially “at risk of being at risk”.