Article Text
Abstract
It is a privilege to have respected colleagues engage with our definition and ethical evaluation of overdiagnosis. In our response to the commentaries, we first deal with paradigmatic issues: the place of realism, the relationship between diagnostic standards and correctness and the distinction between overdiagnosis and both false-positives and medicalisation. We then discuss issues arising across the commentaries in turn. Our definition captures the range of different types of overdiagnosis, unlike a definition limited to diagnosis of harmless disease. Certain implications do flow from our definition, as noted by commentators, but we do not view them as problematic: overdiagnoses can become beneficial diagnoses as medical knowledge and practice changes over time; inadequate systems of healthcare can produce tragic overdiagnosis, and the effectiveness of treatment partly determines whether overdiagnosis occurs. Complexity and uncertainty in balancing benefits and harms is unfortunate, but not a reason to avoid making a judgement (ideally one that reflects multiple perspectives). We reaffirm that overdiagnosis, for the foreseeable future, must be estimated at a population level and defend the importance of good-quality risk communication for individuals. We acknowledge that a lot turns on the relevance of professional communities in our definition and expand our reasoning in this regard then conclude with a note on the difference between intentions and goals. We expect that it will be some time before these matters are settled and we look forward to continue debating these matters with our colleagues.
- Clinical Ethics
- Philosophy of Medicine
- Public Health Ethics
- Allocation of Health Care Resources
Statistics from Altmetric.com
Footnotes
Twitter Follow Stacy Carter at @stacymcarter
Contributors All authors drafted text and/or contributed original ideas in response to the commentaries. SMC led the analysis and writing. All authors contributed to the iterative development of the final argument.
Funding National Health and Medical Research Council (grant nos. 1023197, 1104136).
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Copyright information:
Linked Articles
Read the full text or download the PDF:
Other content recommended for you
- A definition and ethical evaluation of overdiagnosis
- Defining and evaluating overdiagnosis
- Evidence of potential overdiagnosis and overtreatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents: protocol for a scoping review
- Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome
- Casting the net too wide on overdiagnosis: benefits, burdens and non-harmful disease
- Should women aged 70–74 be invited to participate in screening mammography? A report on two Australian community juries
- Citizens ’ juries can bring public voices on overdiagnosis into policy making
- Attention - deficit / hyperactivity disorder: are we helping or harming
- Early head injury and attention deficit hyperactivity disorder: retrospective cohort study
- Words do matter: a systematic review on how different terminology for the same condition influences management preferences