Dr. Arjun Rajagopalan discusses the issue of overdiagnosis in medicine, highlighting various drivers such as technological advancements, misconceptions about utility, and vested interests. He presents examples of overdiagnosed conditions, including asthma and breast cancer, where a significant percentage of patients may not require treatment. The document emphasizes that increased testing and treatment may harm rather than help patients, challenging the traditional perception of medicine's benefits.

1. Dr Arjun Rajagopalan
Overdiagnosis “Medicine’s much hailed ability to
help the sick is fast being
challenged by its propensity to harm
the healthy. A burgeoning scientific
literature is fuelling public concerns
that too many people are
overdosed, overtreated,
and
overdiagnosed.“
An embarrassment of riches
BMJ 2012:344. 29 May 2012

2. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Technological advances
Introduction of new, more
powerful, less invasive
technologies for diagnosis
and treatment inevitably
leads to deployment of
these tools in a poorly
controlled fashion.
Citius, Altius, Fortius

3. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Misconceptions of utility
A mistaken belief that
more is better.
Blind, untested faith in early
detection not substantiated by
evidence and heedless of risks.
More is better

4. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Treatment by committee
Conflicted panels, driven by
political correctness and desiring
to please all, producing
expanded definitions and writing
conciliatory guidelines.
Consensus of the ill informed

5. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Vested interests
Doctor-owned facilities.
Private, for-profit medical
businesses.
Doctors in the pay of business
interests sitting on panels.
Hand in purse

6. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Defensive Medicine
Ever increasing litigation and
ballooning awards.
I don’t think it is needed,
but …

7. Dr Arjun Rajagopalan
Drivers of over diagnosis:
Panel preference
Ordering a range of tests when one
or two will be enough.
The whole kitchen sink,
not just the spoons

8. Dr Arjun Rajagopalan
Some common examples
Condition Overdiagnosis
Asthma
30% may not have asthma
66% may not require medications
Breast cancer
Upto 1/3 of mammographically detected
“cancers” may be overdiagnosed
Chronic kidney
disease (CKD)
1 in 10 classified as CKD under present criteria
Overdiagnosis in the elderly
High BP Substantial overdiagnosis
High cholesterol
Up to 80% of people with near normal
cholesterol treated for life may be overdiagnosed
Prostate cancer
Overdiagnosis of 60% in those detected using
the prostate specific antigen (PSA) test