Overdiagnosis across medical disciplines: a scoping review | BMJ Open

Curious about which areas of medicine have more problems with overdiagnosis than others? Wondering in which fields the problem has been studied extensively? A group from the Netherlands has looked into this extensively in their paper: Overdiagnosis across medical disciplines: a scoping review for BMJ Open.

One of the biggest challenges in exploring this area is that the problem of 'too much medicine' goes by many different terms, these vary from place to place, and even where the same term is used there is disagreement about definitions. 

Jenniskens, a PhD student at Utrecht University, et al looked at almost 5000 studies and included 1581 for review. Unsurprisingly, the majority of papers pertained to the field of oncology, perhaps because wide-spread screening programs and attempts for early diagnosis are much more common for cancer than for chronic disease and other conditions. Though they did not publish the information, they also took a moment to determine from where in the world the papers were being written.

For years, I have been fascinated with the geographically diverse response to the problem of overdiagnosis and the idea that overdiagnosis can happen in resource-rich and -poor countries alike. I worked with Alan Cassels to facilitate a group discussion at the Preventing Overdiagnosis conference in Barcelona in 2016. We identified movements that attempt to combat overuse of tests, treatments, and procedures around the world (presentation slides are available here) and discussed what factors in each region might be playing a role.

Seeing that presentation and recognizing my interest, Mr Jenniskens has since kindly provided me with a breakdown of the country of origin of the authors for the papers analyzed in his group's review. While most of the papers were tied to the United States, first authors from 65 different countries were among the 1581 papers.

Grey - no authors; Light Green - few authors; Orange - many authors.

Grey - no authors; Light Green - few authors; Orange - many authors.

Please click through to interactive map to view the % proportion of authors of the 1581 assessed papers, originating from each country. From Albania to Zimbabwe, it is clear that overdiagnosis is a global concern, and is being researched everywhere.

Read more about the papers considered in the scoping review.

Source: http://bmjopen.bmj.com/content/7/12/e01844...

PODCAST: Questioning Medicine - Statin showdown

When it comes to statin dosing, um, what is the right dose?

Drs Joe Weatherly and Andrew Buelt of Questioning Medicine tackle this question as they review the evidence on statin dosing in their latest podcast. They also do a nice shout out to Less is More Med, but get into dangerous territory by bragging to a Canadian about their hockey team.*

Anyway, they do know a lot more about statins than they know about hockey; this is the fourth in a series of 5 shows devoted to critical appraisal of statin studies. The whole collection is here at Podomatic. 

The pair also run a blog at MedPage Today, Questioning Medicine; though less frequently updated, their posts are great at tackling some of the assumptions we make.

Kayexelate to lower potassium? Maybe not that effective. Pelvic Exams? Probably unnecessary and likely harmful. What Joe and Andrew write always provides a gentle reminder to readers that our thinking "it might not help but it probably doesn't hurt" is off-base; there's plenty of evidence to back a change in practice for the better.

Like their style? You'll also love the other groups that act as Evidence-Based Medicine champions and 'medical mythbusters,' providing sharp (and sometimes hilarious) critical reviews of the latest evidence.

 

* While Tampa Bay did pretty well this NHL Playoff season, these guys will have to be careful about bragging about their success, given that the Lightening's roster is primary comprised of Canadian players. 

Source: http://questioningmed40708.podomatic.com/e...

Other Blogs: Less Is More | An index of evidence-based, “less-medical” patient care

More "Less is More"!

Dr Bill Cayley Jr has started a Wordpress Blog, "Less is More EBM" to review studies that explore situations in which less involved/invasive/expensive/difficult/novel/etc. care is actually best for patients.

He writes, "This index is currently a personal (and extremely part-time!) project aiming to catalog literature documenting when “less is more” in a searchable and accessible format." It has just started, but there are already insights on papers about overuse of arthroscopy, the best treatment for paediatric upper respiratory infection, and creative solutions for low resource areas (eg. mosquito nets instead of mesh for hernia repair).

It's great to see interest booming. More people are writing books and blogs, talking at conferences, changing the care they deliver, and asking questions of their health care provider. The movement – still known by many names, a few of which are highlighted in the glossary – is growing!

If you are particularly interested in blogs, look at the left sidebar column, and under 'Similar Blogs' you'll find others writing about similar issues as you'll find on this site. Check 'em out!

Source: https://lessismoreebm.wordpress.com/

A summary: How to prevent #overdiagnosis @SwissMedWkly

For anyone who is even remotely interested in the movement to prevent overdiagnosis, I suggest you check out this article, How to Prevent Overdiagnosis, in its entirety.

Dr Arnaud Chiolero et al. have provided a thorough overview of the causes of overdiagnosis, methods to estimate the frequency of overdiagnosis, and interventions to prevent overdiagnosis.

As a teaser, I present to you the summary tables from the article:

We all might argue about the exact contributors to overdiagnosis, but this list (based on a review of the literature) is pretty thorough. Fortunately there is hope to combat the problem, and some specific examples are given:

See the article or follow Dr Chiolero (@swissepi) on Twitter for more.

Source: http://www.smw.ch/content/smw-2015-14060/