Globally there is increasing concern about the impact of "overdiagnosis" on both the overtreatment of patients and as a major contributor to rising health care costs. Recent activities in this area include the ABIM's Choosing Wisely campaign (www.choosingwisely.org/), JAMA Internal Medicine's “Less is More” series, the BMJ’s Too Much Medicine series (www.bmj.com/too-much-medicine) and the controversy over the expanded definitions of psychiatric illness in the recent DSM-5 release (www.psychologytoday.com/blog/dsm5-in-distress).
Currently we have no specific rules or guidance on when and how the definitions of diseases should be modified. A recent study published in PLOS Medicine[Moynihan, 2013]] highlighted the tendency of disease definitions to widen: of 16 guidelines on 14 common conditions, 10 proposed changes widening, 1 narrowing definitions, and 5 were unclear. The widening fell into three categories: creating ‘‘pre-disease’’ (such as pre-hypertension and pre-clinical Alzheimer’s); lowering diagnostic thresholds or boundaries (such as diabetes, and depression); and proposing earlier or different diagnostic methods (such as single scan diagnosis for multiple sclerosis). None of the 16 guidelines included a rigorous assessment of potential harms of proposed definitions changes. There were also considerable conflicts of interest within the committees, including the committee chairs.
Aims and Objectives of the Working Group
a) To set an internationally acceptable set of rules and guidance on the requirements for modifying the definitions of diseases.
b) Provide guidance to guideline developers who are considering a change to the definition or thresholds for specific diseases, or developing new clinical categories.
If you are a G-I-N member and are interested in participating in the activities of the Overdiagnosis working group please email email@example.com