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Re: Hofmann et al. Overdiagnosis, one concept, three perspectives, and a model
European Journal of Epidemiology ( IF 13.6 ) Pub Date : 2021-07-18 , DOI: 10.1007/s10654-021-00773-1
Emma Grundtvig Gram 1 , John Brodersen 1, 2 , Christoffer Bjerre Haase 1, 3 , Frederik Martiny 1, 4 , Olsi Kusta 1 , Christina Sadolin Damhus 1
Affiliation  

It is with great interest we have read the article “Overdiagnosis: one concept, three perspectives, and a model” by Hofmann and colleagues. We share the authors’ ambition of understanding what overdiagnosis is and what it isn’t. In our research, we define overdiagnosis on the basis of two interrelated phenomena: overdetection and overdefinition. Overdetection is the labelling of a person with a disease or abnormal condition, that would not have caused the person harm, e.g., symptoms or death, if left undiscovered. Overdefinition is the creation of new diagnoses by overmedicalising ordinary life experiences or expanding existing diagnoses by lowering thresholds or widening diagnostic criteria, without evidence of improved outcomes. These phenomena have different causes and thereby often different drivers. However, they have one important consequence in common: people are turned into patients unnecessarily, i.e., overdiagnosed. On a personal level, overdiagnosis cause various types of harms, including physical, psychological, social and financial harm. On a societal level, overdiagnosis may also cause harm to public health, cause resource waste, and cultural changes with overmedicalisation of normal life events. By definition, none of the aforementioned phenomena lead to any clinical benefit. Therefore, we disagree with Hofmann and colleagues’ definition of overdiagnosis as diagnoses that “…on balance, do more harm than good.”. We argue that introducing balance and benefits to the definition of overdiagnosis complicates the concept unnecessarily and cause problems operationalising overdiagnosis.



中文翻译:

回复:霍夫曼等人。过度诊断,一个概念,三个视角,一个模型

我们怀着极大的兴趣阅读了 Hofmann 及其同事的文章“过度诊断:一个概念、三个视角和一个模型”。我们分享作者的雄心,即理解什么是过度诊断,什么不是。在我们的研究中,我们根据两个相互关联的现象来定义过度诊断:过度检测和过度定义。过度检测是对患有疾病或异常状况的人进行标记,如果不加以发现,则不会对该人造成伤害,例如症状或死亡。过度定义是通过对普通生活经历过度医学化或通过降低阈值或扩大诊断标准来扩大现有诊断来创造新的诊断,而没有改善结果的证据。这些现象有不同的原因,因此往往有不同的驱动因素。然而,它们有一个共同的重要后果:人们不必要地变成了病人,即过度诊断。在个人层面上,过度诊断会导致各种类型的伤害,包括身体、心理、社会和经济上的伤害。在社会层面,过度诊断还可能危害公众健康,造成资源浪费,以及因对正常生活事件过度医疗化而导致的文化变革。根据定义,上述现象都不会带来任何临床益处。因此,我们不同意 Hofmann 及其同事将过度诊断定义为“…… 过度诊断还可能对公众健康造成危害,造成资源浪费,以及因对正常生活事件过度医疗化而导致的文化变革。根据定义,上述现象都不会带来任何临床益处。因此,我们不同意 Hofmann 及其同事将过度诊断定义为“…… 过度诊断还可能对公众健康造成危害,造成资源浪费,以及因对正常生活事件过度医疗化而导致的文化变革。根据定义,上述现象都不会带来任何临床益处。因此,我们不同意 Hofmann 及其同事将过度诊断定义为“……总的来说,弊大于利。”。我们认为,在过度诊断的定义中引入平衡和好处会使概念不必要地复杂化,并导致过度诊断的操作问题。

更新日期:2021-07-19
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