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Defining and evaluating overdiagnosis
  1. Bjørn Hofmann1,2
  1. 1Department Health, Technology and Society, The Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway
  2. 2Centre for Medical Ethics, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Bjørn Hofmann, University of Oslo, Centre for Medical Ethics, P. O. Box 1130, Blindern, Oslo N0318, Norway; b.m.hofmann{at}medisin.uio.no

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In their excellent article, Carter and colleagues provide us with a definition of overdiagnosis and an analysis of the ethical implications of overdiagnosis in accordance with an elaborated typology. Clarification of overdiagnosis is strongly needed as there are heated debates on overdiagnosis, both with regards to its existence, extension and its effects. While some claim that overdiagnosis is of little or no problem, others see it as a reason to stop screening.1

In this troubled water, Carter and colleagues are brave as they have taken on the task to define overdiagnosis. Even more, they have decided to do so by fighting at two fronts at the same time. The first front is against those who argue that overdiagnosis does not exist or is a minor problem, for example, because it cannot be observed directly. The second front is against those who think that diseases are objective and that diagnostic judgments correspond to a material reality. As the authors point out, diagnostic entities are established through practices. This combined approach appears plausible because when people do not believe that overdiagnosis exists as objective events corresponding to material entities, it may be a wise strategy to show that these entities do exist in practices. However, as I will point out below, this comes at a significant cost.

Let me start with acknowledging the well-structured analysis of overdiagnosis, the substantiated definition of overdiagnosis and the very interesting analysis of the ethical implications. I also endorse their initial point that diagnoses and diseases are established through practices, for example, framed by technological innovations.2

The novelty of their approach lies in differentiating between the acceptance by a relevant professional community of the identification of a condition (which is labelled or diagnosed) and the assessment of whether this identification has an unfavourable balance between …

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