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?
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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.
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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.
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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.
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That’s it!
p.s. I do recommend the book.
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