Superfluous Healing Zeal

"We recently published a comprehensive analysis in the BMJ [British Medical Journal] of possible drivers of overdiagnosis and potential solutions. Causes range from cultural beliefs that 'more is better' in medicine, to financial incentives driving unnecessary tests and treatments."
"The good news is that doctors' groups across the globe are now publicly acknowledging the problem of overdiagnosis."
"As our BMJ analysis highlights, there are many potential solutions. There's an urgent need for public information and awareness campaigns. Mew educational curricula for health professionals are a priority. And screening programs need to be reformed to make sure we're only targeting those at high risk."
Ray Moynihan, senior research fellow, Bond University, Gold Coast, Australia

There is nothing particularly new about the awareness among the general public that diagnoses of attention deficit hyperactivity in children has gotten out of hand, that it has become too common for parents faced with hyper-energetic children who balk at being disciplined, claim that their children's behaviour is abnormal and requires treatment. Treatment usually comes in the form of a prescription medication once the 'diagnosis' is made, and parents are finally able to find some peace from the ungoverned antics of their children.

In a busy world where there is so much that demands attention, where we have little patience for the normal unfolding of childhood traits and personalities, frustrated parents sometimes prefer to view their children through the lens of pacification through drugs. With both parents working outside the home, time is compressed and it takes what seems like a Herculean effort to reason with a child continually to teach that child that there are limits to patience and everyone has an obligation to fit into a social structure, from the family environment to the larger exterior world.

We have medicalized the process of childhood adventuring into social convention. Whereas a study of a million childen in Canada found December-born children more likely than those born in January to be the recipient of an ADHD diagnosis; pathologizing immaturity turns out to be the issue. But that is just one outstanding problem in seeing an abnormality calling out to be treated in a perfectly normal unfolding of a child's growing awareness of the world surrounding him and his place in it.

These are routine and not-too-routine behavioral problems for which moderation and patience, wisdom and judgement are called for, not chemicalizing children into submission.

On to other issues, such as various types of cancers being overdiagnosed. In this instance, overdiagnosis results when an emerging symptom is felt to be reflective of a danger and is treated as such. A tripling of thyroid cancer diagnoses has occurred in recent decades and in the instance of very small tumours in particular, according to research published in The New England Journal of Medicine in 2016. Researchers point out that all too often many of those very small tumours are benign.

Getty Images: Equipment in a typical doctor's office

Yet patients diagnosed with these tumours are subjected routinely to serious operations and prescribed the use of unneeded drugs. According to the research, in excess of a half-million people may have been victims of such overdiagnoses across a dozen countries in the past two decades. One might be mistaken in the belief and trust that such tumours would undergo a pre-surgical biopsy to determine whether they are benign or indeed potentially lethal before embarking on surgery.

Which brings us to prostate cancer, yet another type of cancer which medical science has long acknowledged that men in their very mature years can live with without resorting to dangerous surgeries which often result in irreversible consequences impacting on the quality of the patient's life. Despite the knowledge that older men can have prostate cancer without danger to their normal life span, the issue of unnecessary diagnoses and over-treatment continues to plague this particular cancer.

Estimates recently reported from the United States reveal that between 20 to 50 percent of prostate cancers diagnosed through screening may be overdiagnosed. No harm would have resulted to those with prostate cancer in their elder years had the cancer been undetected. Which is not to say that there are times when such cancers in younger men can be aggressive and threatening, and require reaction in surgery, but it is vastly overdone. Those in the health profession should be aware of when it is appropriate to react to prostate cancer; it is an issue where one size does not fit all.

As far as breast cancers are concerned, a major independent review of evidence on a global scale suggests that 19 percent of diagnosed breast cancers resulting from mammograhy screening may also be overdiagnosed, that the tumours would not have been the cause of harm, simply because, they were benign. Again, this is where a biopsy routinely conducted would clear up any misconceptions. Estimates of overdiagoses in breast cancers for Australia rated a higher figure of 30 percent.

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