clinical focus
Sometimes we know too much
Science has greatly improved the ability to diagnose diseases, but treating every malady detected may do more harm than good.
By Dallas Bastian and Andrew Bracey
New diagnostic and screening technologies may be doing more harm than good in some cases.
This was a key point raised during a public forum on the issue of overdiagnosis and overtreatment.
Public health researchers from the University of Sydney considered the idea that sometimes being tested for too many things and knowing too much can lead to poor health.
Ethicist associate professor Stacy Carter, from the university, says:“ This is a counterintuitive idea, but it’ s the idea that sometimes we have things that can be correctly classified as diseases – we can find them on the test and that test is correct – but intervening in that disease is not going to help us, either because the disease was never going to cause us any harm, so we didn’ t really need to know that it was there, or because the treatment is disproportionate to the problem.”
Carter says the study – a collaboration between the University of Sydney, Bond University, Monash University and The George Institute – represents the first major grant funding to support research into overdiagnosis and over-treatment internationally.
“ This a place in which Australia is really leading the world in research,” she explains.“ It’ s specifically tailored to build up a new cohort of young investigators, so most of that money will go to support PhD scholarships and places for post-doctoral scholars – young scholars who have just finished their PhDs.“ That will begin to build a critical mass of young researchers who are interested in this problem of overdiagnosis and overtreatment in Australia and internationally and what we can do about it.”
Carter’ s research team was recently awarded a $ 2.5 million NHMRC grant to establish a Centre for Research Excellence( CRE). The centre aims to develop strategies to mitigate the overdiagnosis and overtreatment issue.
CRE chief investigator professor Alexandra Barratt, from the University of Sydney’ s School of Public Health, says:“ Recently, we have witnessed an explosion of new diagnostic and screening technologies available, including advanced imaging, biomarkers and genomic tests – some of these tests are even marketed directly to the public.
“ Ideally, these tests improve health by identifying diseases or risks that need to be treated. However, sometimes these tests lead to overdiagnosis and overtreatment, which not only harms patients but also wastes health resources through unnecessary procedures.”
Barratt says the CRE will focus on cancer and cardiovascular disease.“ New diagnostics are already appearing in clinical use in these areas, and these diseases account for a large burden of death, disease and healthcare spending in Australia,” she explains.
The CRE is the first part of Wiser Healthcare: a research collaboration to reduce overdiagnosis and overtreatment.
Carter says:“ The Centre for Research Excellence, which we [ recently launched ], has a number of exciting projects within it. [ The CRE ] incorporates a project in which we’ re trying to [ establish ] methodologies for working out that overdiagnosis might be happening very early in the life of a technology, so that we can minimise harm as best we can and as early as we can. [ It also includes ] an innovative project working with journalists to try to change the discourse about overdiagnosis and overtreatment in Australia.”
She adds that genomics, which she describes as a“ rapidly-growing and very important area” has great potential to benefit patients but is an example of a field that still carries“ quite a great risk of overdiagnosis”.
“ We will be focused both on measuring and understanding the problem, and on generating and testing solutions, so we can reorient the healthcare system in Australia and the [ rest of the ] world to maximise benefit for all and minimise harm.” ■
26 agedcareinsite. com. au