3/29/2015 Framing Overdiagnosis Jared Rhoads, MS, MPH’16 BRI Student Conference March 2015 We’re great at finding abnormalities! tiny lung nodule miniscule kidney cyst T1a prostate tumor Our ability to detect small things is really good. … but are they really problems? 1 3/29/2015 Not every cancer is destined to cause harm (i.e., overdiagnosis) Credit: H. Gilbert Welch, The Dartmouth Institute Definition Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. 2 3/29/2015 Why is it a problem? Because practically all treatments carry some risk of harm or side effects. And, everything involves financial costs. Right now, overdiagnosis is a medical/epidemiological story. But I think it’s coming to the policy world. 3 3/29/2015 We don’t have a great understanding yet of the benefits and risks of various treatments. We don’t have a great understanding yet of the benefits and risks of various treatments. AND AND We don’t want to overdiagnose and overtreat. We don’t want to overdiagnose and overtreat. THEREFORE THEREFORE Let’s have a group of experts in Washington determine what’s best, on average, for the population, and make everyone comply. Let’s have each patient choose, in consultation with his or her doctor, which treatments and risks make sense for him or her. Some takeaways • As descriptive epidemiology, I think the overdiagnosis story/concept is useful and real. • But I’m concerned that it will be co-opted by central planner types who want to use it to dictate care via reimbursement rules (think Medicare IPAB) in the name of adhering to evidence-based care. • I’d like to see it become part of the argument for greater patient empowerment, consumerism, and shared decision making. 4 3/29/2015 That’s it! p.s. I do recommend the book. 5
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