From Quebec to Copenhagen: Annual Preventing Overdiagnosis Conference Raises Awareness Around the Globe

As the 5^th international Preventing Overdiagnosis conference adjourned in Quebec City, Quebec, Canada, this past summer, plans were already underway for 6^th annual conference scheduled in Copenhagen, Denmark, August 20-22, 2018. The theme of the 2017 conference “Towards Responsible Global Solutions” mirrored the growing awareness among health care professionals, policy makers, and the public that overdiagnosis and overtreatment are legitimate areas of concern that can be addressed through practice and policy changes.

 The Dartmouth Institute, widely recognized for its pioneering research on overdiagnosis and overtreatment, is a founding collaborator of the conference, along with Oxford’s Center for Evidence-Based Medicine (CEBM), Consumer Reports, The BMJ, Bond University, and Wiser Healthcare. The organizations created the forum to advance research, stimulate policy change, and foster open communication on overdiagnosis. The inaugural conference was held at Dartmouth in 2013.

“I think there is a traditional way of thinking in medicine that ‘more is always better’ or ‘better safe than sorry,’ where ‘safe’ means doing more,” said Dartmouth Institute Professor Lisa Schwartz. “But there is a growing awareness that more may not be better, and that overdiagnosis through overtesting or expanded disease definitions can harm patients and waste resources that might have been put to good use.” Schwartz and research partner Dartmouth Institute Professor Steven Woloshin represented the Institute at the conference—introducing the meeting and chairing the opening plenary session, Moving from Evidence to Action, which featured Quebec's Health Minister, as well as parallel and breakout sessions on Overuse and Overmedicalisation. Articles from the conference were published in BMJ’s “Too Much Medicine” Overdiagnosis series focuses on winding back the harms. Topics included an analysis of possible causes of overdiagnosis and potential solutions; expansion of disease definitions, specifically polycystic ovary disease, which may do more to frighten young women about their fertility than prevent harm; and two articles illustrating how testing can fuel overdiagnosis. In 2006, there were approximately 200 news stories on overdiagnosis according to Lexis-Nexis by 2016 there were close to 1,200.

 In their BMJ opinion piece that introduces the conference series, Schwartz and Woloshin also point out that overdiagnosis, once considered a “fringe idea” has moved into the mainstream, with the number of journal and media articles addressing the issue increasing exponentially over the past decade.

 Perhaps most importantly, efforts to address overdiagnosis and mitigate its harms have also begun to proliferate. At the 2015 conference in Barcelona, Catherine Calderwood, chief medical officer of Scotland, identified overdiagnosis and overmedicalization as her major public health challenge and outlined her proposal of ‘Realistic Medicine’ as the appropriate policy response. In the same session, Dartmouth Professor of Radiology William Black cited an example of physician leadership on overdiagnosis; reporting on how radiologists were taking the lead in curbing overdiagnosis by considering whether to raise the bar to act on pulmonary nodules which might conceivably be cancer. In a highly unusual move, the Fleischer Society Guidelines, those most commonly followed by radiologists, actually raised the bar in response to evidence that too many people were being unnecessarily diagnosed with nodules that have a very low probability of being cancer.

 “We see these types of initiatives being taken up in many countries,” Woloshin said, “Due to its international makeup, the conference is where we can share ideas and begin to think about what might be successful in our countries and health systems.”

 Dartmouth continues as a leading voice in planning the 2018 Preventing Overdiagnosis conference with Schwartz and Woloshin serving on the conference board and scientific program committee.  

 For more information about the 2018 international Preventing Overdiagnosis conference in Copenhagen, Denmark, in August 20-22, 2018: 

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POSTED 10/19/2017 AT 01:28 PM IN #research #home