The triumph of medicine: how overdiagnosis is turning healthy people into patients

Extract

More and more of our medical activity focuses on ‘finding things early’. Based on a longitudinal model of disease, we aim to find disease in a pre-clinical stage when a person does not experience any symptoms, hoping that by intervening early we can avoid the clinical stage when symptoms do occur and ultimately prevent that person to die prematurely. Paradoxically, this optimistic scenario has now become an important threat to the health of our patients.

The crucial problem is that not every pre-clinical disease will automatically progress to clinical disease. Detecting pre-clinical disease that will not cause any symptoms or early death is called overdiagnosis. These people would never have experienced any symptoms and their life expectancy would not have been affected, if they had been left undiagnosed. However, because we are unable to differentiate overdiagnosis from true diagnosis, people with overdiagnosis are treated as truly diseased patients, which in their case causes harm without benefit.