Monday, September 15, 2014

Preventing overdiagnosis: conference (#PODC2014) and Public Citizen

A year ago, I was fortunate enough to attend the first Preventing Overdiagnosis conference in Dartmouth, New Hampshire. This annual worldwide gathering of researchers, clinicians, and laypersons aims to explore the increasing problem of overdiagnosis in modern medicine and propose strategies to restrict the identification and treatment of disease to those persons who stand to benefit, rather than others in whom unnecessary diagnosis will only lead to harm. Prostate cancer is the "poster child" for overdiagnosis, a condition that I've compared in the past to an epidemic of snipers on rooftops where aggressive efforts to "disarm the sniper" often result in devastating consequences for men who would have otherwise died with, rather than of, the condition.

The second Preventing Overdiagnosis conference in Oxford, UK began today and continues through Wednesday, September 17th. Although I didn't make it this year, I plan to follow the scientific sessions on Twitter (hashtag #PODC2014) and encourage readers to do so as well.

Speaking of overdiagnosis, my colleagues at Public Citizen have recently taken aim at direct-to-consumer cardiovascular screenings offered at 20 hospitals and medical institutions in conjunction with HealthFair, a for-profit company that provides echocardiography, electrocardiography, abdominal ultrasonography, carotid ultrasonography to all comers. As Public Citizen's experts pointed out in letters to the Federal Trade Commission, the Joint Commission, and involved hospitals and institutions, no credible medical organization supports indiscriminately providing these tests to asymptomatic patients, since they are likely to cause more harm than good by producing false positive results or leading to interventions for conditions that would not otherwise produce clinical symptoms (in other words, overdiagnosis). In fact, the U.S. Preventive Services Task Force and several primary care and cardiology groups involved in the American Board of Internal Medicine Foundation's Choosing Wisely campaign recommend against performing many of these tests.

Kudos to the organizers and participants in this year's Preventing Overdiagnosis conference, and to Drs. Michael Carome and Sidney Wolfe at Public Citizen, for their commendable efforts to protect patients from the harms of overtesting, overdiagnosis, and overtreatment.