Marketing disease spurs overdiagnosis

Published 11.07.2018
Author Virpi Ekholm
Photos Olli-Pekka Latvala
Seija Eskelinen works at Duodecim Medical Publications as Editor in Chief of Omahoitopalvelut, which is a databank of self-care services. She held a presentation about "Incentives of overdiagnosis” at Tampereen Lääkäripäivät, an education event for physicians in Tampere, on March 21st 2018.
Seija Eskelinen works at Duodecim Medical Publications as Editor in Chief of Omahoitopalvelut, which is a databank of self-care services. She held a presentation about "Incentives of overdiagnosis” at Tampereen Lääkäripäivät, an education event for physicians in Tampere, on March 21st 2018.

Medicine is currently expanding in a way that does not benefit health and may actually cause harm in the worst cases, warns Specialist in Primary Care Seija Eskelinen from Duodecim Medical Publications.

Are you tired? Maybe you are feeling livelier now that spring is here, but were you tired in November?

Maybe you suffer from hypothyroidism that is not visible in laboratory tests? Testosterone deficiency? Latent iron deficiency or vitamin B12 deficiency?

All these diagnoses are readily available to a tired person, even though the feeling of tiredness may be caused by darkness and stress, for example.

If a patient goes to see a doctor because of tiredness and the physician decides to try a treatment, the check-up will be scheduled for March. Anyone would have perked up by that time of year, no matter what you do, says Specialist in Primary Care Seija Eskelinen.

Overdiagnosis is driven by a number of factors: The idea that physicians must always seek to prevent a serious illness at an early stage, overconfidence in technology, individualized prevention of disease and economic interests.

All of this leads to a situation where normal, everyday problems such as tiredness or loneliness are turned into illnesses requiring medication.

Keeping expanding disease criteria sensible

One way to increase the number of people being treated is to change the diagnostic criteria of diseases so that milder symptoms or lower laboratory values are interpreted as an illness requiring treatment.

In Finland, working groups that produce Duodecim’s Current Care Guidelines are implementing a checklist which seeks to prevent overdiagnosis.

When planning the expansion of the diagnostic criteria of a disease, it is crucial to assess how implementation of the new criteria would affect the incidence and prevalence. What benefit or harm would implementation of the new criteria cause for patients?

Seija Eskelinen notes that economic interests often play a part in overdiagnosis. Diseases are marketed and minor health complaints medicalized in order to get people to ask for tests and seek treatment.

For instance, one private hospital markets PSA tests to men over fifty year after year. The marketing material does not explain why PSA is a poor screening test.

Fear of disease feeds overdiagnosis

Physicians’ attitudes also have an influence on what tests they order for their patients.

The fear of disease is widespread among physicians, patients and authorities. Something going unnoticed is feared more than the negative consequences of overdiagnosis, Seija Eskelinen summarizes.

According to a study conducted in Australia, a physician is most likely to order a PSA test for an asymptomatic man if they believe their first priority is to avoid underdiagnosis. These physicians also offered the test to men that had not requested it themselves.

If, on the other hand, the physician seeks to avoid overdiagnosis, they will most likely only order a PSA test for the man if he asks for it and still wants it after a thorough discussion about it.

Eskelinen thinks physicians and potential patients should be aware of the negative consequences of overdiagnosis. Even though the patient may be satisfied after receiving a laboratory referral or a prescription, that does not necessarily improve their health or wellbeing.

Trust in the medical profession is dependent on how well it fulfils its ethical responsibility to cause no harm. Medicine is currently expanding in a way that does not benefit health and may actually cause harm in the worst cases, warns Eskelinen.

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