Most GPs will recognise the dispiriting conversation that can happen when a patient discovers that they have Chronic Kidney Disease Stage 3 (CKD). “A disease? Where did I catch it from? Will the grandkids get it? What is the treatment?” Patients know what a disease is; a condition that you acquire or catch, that makes […]
Category: Too much medicine
Richard Smith: Doctors phishing for phools
In their influential book Phishing for Phools: The Economics of Manipulation and Deception two Nobel prize winners, George A Akerlof and Robert J Shiller, describe how businesses profit from exploiting human weakness. Politicians do the same and so, I suggest, do doctors. (I was about to assume that all BMJ readers know about phishing, but […]
Avril Danczak: Selling statins to patients
“Are you ashamed of yourself now?” This was a patient’s response when her doctor wanted to start her on a statin. Every week I work with up to 30 General Practitioners in Training on their study day for general practice, and one of them shared the difficult conversation that had surrounded this comment. I had […]
Georg Röggla: Choosing wisely in Germany
I attended the annual convention of the German Society of Internal Medicine DGIM (Deutsche Gesellschaft für Innere Medizin) in Mannheim this week. The main focus of this congress is transferring knowledge from bench to bedside and a large proportion of participants are primarily clinicians. I was interested to see that a BMJ topic was one […]
Saurabh Jha: Saving Normal
The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, […]
Navjoyt Ladher: Preventing Overdiagnosis 2015—winding back the harms of too much medicine
“Medical science has made such tremendous progress that there is hardly a healthy human left”—Aldous Huxley Today sees the start of the third annual Preventing Overdiagnosis conference, this year hosted by the National Cancer Institute in Washington DC. The BMJ has been a partner in this event since its inception and it forms an important […]
Jack O’Sullivan: Managing overdiagnosis
“Hardly more effective than a coin toss.” The damming words from the discoverer of prostate specific antigen (PSA) poignantly reflect the controversies of prostate cancer screening. In fact, Richard J Albin’s principle criticism—”(PSA testing) can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t“—highlights […]
Helen Macdonald: Discussing clot busters for stroke in the mainstream media
A recent episode of File on 4, entitled “Treating Stroke: The Doctor’s Dilemma,” discusses the latest on the only clot buster for ischaemic stroke—alteplase—and touches on broader debate that will be familiar to the medical community, but less so to a lay audience. Alteplase is currently being examined by the Medicines and Healthcare Regulatory Agency (MHRA) after […]
William Cayley: Are you depressed?
“Do you feel down, depressed, or hopeless? Are you bothered by little interest or pleasure in doing things?” Now that the practice I work for is part of an accountable care organization, one more measure on which our (supposed quality of) patient care is being assessed, is our screening for depression. While that sounds initially […]
Carlos Martins: Overuse of medical tests—a new health risk factor?
A risk factor is, among other things, an aspect of personal behaviour or lifestyle that, on the basis of epidemiologic evidence, is known to be associated with health related conditions considered important to prevent (1). A new behaviour may be observed in the general population of western countries; a behaviour related to the way patients use medical services […]