This guest blog was written by Juan V. A. Franco from Centro Cochrane, who attended Preventing Overdiagnosis 2016 in Barcelona.
The Preventing Overdiagnosis Conference held in Barcelona last month gathered over 400 participants from across the world. Many voices were heard since plurality was represented in the presence of patient representatives, health care professionals, researchers, and journalists among others.
This year, the conference featured Spanish-speaking sessions, where the local Spanish scientific societies alongside Latin American representatives, presented innovative activities and research, allowing the possibility for wider networking. The beautiful city of Barcelona, with its pitch blue sky and sunny seaside by the Centre de Convencions Internacional de Barcelona (CCIB) was a wonderful companion throughout the conference.
Numerous research projects have reflected the widespread phenomenon of overdiagnosis, coupled with the widening of disease definitions and overtreatment. The inappropriate use of technology, such as bone density measurements for women at low risk of fracture, CT scans for uncomplicated nephrolithiasis; the disproportionate use of medications in the elderly; the inadequate, and sometimes blatantly false, health coverage by the media, and the wide spectrum of drivers for overdiagnosis and overtreatment were analysed. Fortunately, this dismal prospect was compensated by the many initiatives proposed in order to prevent this phenomena. The involvement of patients and consumers groups; the strong message by researchers campaigning for patient-centred outcomes; the statements made by scientific organisations such as Choosing Wisely and ‘No Hacer’ by semFYC regarding low-value initiatives; and the advocacy for patient-centred care and shared decision making are some examples of a more positive outlook.
However, a great number of initiatives have failed to reverse the advance of too much medicine. Deprescription and deimplementation remain a challenge. The constitution of panels and their conflicts of interest when developing guidelines has raised great controversy. Is it because we don’t fully understand the determinants of overdiagnosis and overtreatment? Is it because we lack the necessary consensus, resources or power to make a change? Are the strategies that we’ve been using the most effective, or are they the same strategies that caused the epidemic of overdiagnosis in the first place? What is the role of the public for this problem?
Many of these questions led a subgroup of researchers to the post-conference Research Planning Day, held on Friday September 23rd. Deimplementation, disease boundaries, payment and regulatory policies, community juries, and shared decision making were the themes for the workshops, which have since led to international networking and the commitment to the development and execution of protocols for high-quality research in this area.
Preventing Overdiagnosis 2016 has raised the bar for future research: we still need to know more about the phenomenon of overdiagnosis and overtreatment, but we must find out how effective strategies can reduce the harms of too much medicine holding a person-centred and community-centred perspective.
Juan V. A. Franco, MD
Servicio Medicina Familiar y Comunitaria – Hospital Italiano de Buenos Aires
Centro Cochrane – Instituto Universitario del Hospital Italiano