"We know harm can come from overdiagnosis ... there is no doubt we need some sort of approach to address it."
- Professor Brendan Murphy, Chief Medical Officer of Australia, Sydney Morning Herald, 2018
Initial Statement to underpin the development of a National Action Plan to Prevent Overdiagnosis and Overtreatment in Australia.
- Alongside the undisputed ability of healthcare to extend human life and ameliorate suffering, there is growing evidence and concern about the problem of too much medicine. Overdiagnosis and the related overuse of medical tests and treatments not only causes harm, but also divert resources from addressing underdiagnosis and undertreatment.
- There is need in Australia to identify the causes of too much medicine, the extent of the problem, and to develop responses to address it.
- There is an urgent need to better inform consumers, clinicians, decision-makers and the public about the evidence for, and the consequences of, overdiagnosis and related overtreatment, as part of a broader approach to inform people about the potential harms, as well as the benefits of medical tests and treatments.
- Expanding disease definitions and lowering diagnostic thresholds are recognised as one driver of the problem, and the processes for changing definitions require meaningful reform.
- We are committed to evaluation, to ensure that attempts to address too much medicine are both safe and fair for healthcare consumers and their families, and in turn help to optimise the Australian health system’s safety, efficiency and equity of access.
- Carter, S.M., W. Rogers, I. Heath, C. Degeling, Doust, A. Barratt et al. (2015). The challenge of overdiagnosis begins with its definition. BMJ, 350: h869
- Thomas, R., S. Sanders, J. Doust, E. Beller, P. Glasziou (2015). Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Pediatrics,135(4): e994-1001
- Jacklyn, G., Glasziou, P.,Macaskill, P., Barratt, A. (2016). Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography. British Journal of Cancer, 114(11): 1269-1276
- Carter, S. M., Degeling, C., Doust, J.,Barratt, A. (2016). A definition and ethical evaluation of overdiagnosis. J Med Ethics, 42: 705-714
- Moynihan, R.(2016). Caution! Diagnosis creep. Australian Prescriber, 39(2):30-31.
- Brownlee, S., Chalkidou, K.,Doust, J., Elshaug, A.G., Glasziou, P., Heath, I., Nagpal, S., Saini, V., Srivastava, D., Chalmers, K., Korenstein, D. (2017) Evidence for overuse of medical services around the world. Lancet, 390(10090): 156-168
- Glasziou, P.,Straus, S., Brownlee, S., Trevena, L., Dans, L., Guyatt, G., Elshaug, A.G., Janett, R., Saini, V. (2017) Evidence for underuse of effective medical services around the world. Lancet, 390(10090): 169-177
- Glasziou, P. Der Tatsache ins Auge sehen: Wir Ärzte tun zu viel (Let’s face the problem: We doctors do too much). Zeitschrift fur Allgemeinmedizin, 93(6): 245-249
- Saini, V., Brownlee, S., Elshaug, A.G., Glasziou, P.,Heath, I. (2017) Addressing overuse and underuse around the world. The Lancet, 390(10090): 105-107.
- Degeling, C., Rychetnik, L., Pickles, K., Thomas, R., Doust, J A.,Gardiner, R.A., Glasziou, P., Newson, A.J. Carter, S.M. (2015). “What should happen before asymptomatic men decide whether or not to have a PSA test?” A report on three community juries. MJA, 203(8): 335-335.
- Thomas, R., Sims, R., Degeling, C., Street, J.M., Carter, S.M., Rychetnik, L., Whitty, J.A., Wilson, A., Ward, P., Glasziou, P.(2016). CJCheck Stage 1 : development and testing of a checklist for reporting community juries – Delphi process and analysis of studies published in 1996 – 2015. Health Expectations, 20(4): 626-637
- Degeling, C., Rychetnik, L., Street, J., Thomas, R.,Carter, S.M. (2017) Influencing health policy through public deliberation: Lessons learned from two decades of Citizens’/community juries. Social Science & Medicine, 179: 166-171.
- Doust, J.,Vandvik, P.O., Qaseem, A., Mustafa, R.A., Horvath, A.R., Frances, A., Al-Ansary, L., Bossuyt, P., Ward, R.L., Kopp, I., Gollogly, L., Schunemann, H., Glasziou, P. (2017). Guidance for Modifying the Definition of Diseases: A Checklist. JAMA Internal Medicine, 177(7): 1020-1025
- Doust, J.,Qaseem, A., Glasziou, P., 2017. Considerations Concerning Disease Redefinition—reply. JAMA internal Medicine, 177(12): 1873-1873.
- Pathirana, T., Clark, J., Moynihan, R. Mapping the drivers of overdiagnosis to potential solutions.BMJ, 358:j3879
- Moynihan, R., Bero, L. (2017) Toward a Healthier Patient Voice: More Independence, Less Industry Funding. JAMA Internal Medicine, 177(3): 350-351.
- Jansen, J., Naganathan, V., Carter, S.M., McLachlan, A., Nickel, B., Irwig, L., Bonner, C., Doust, J.,Heaney, A., Turner, R., McCaffery, K. (2016). Too much medicine in older people? Deprescribing through shared decision making. BMJ, 353:i2893
- Doust, J.,Jean Walker, M., Rogers, W.A. (2017). Current Dilemmas in Defining the Boundaries of Disease. Journal of Medicine and Philosophy, 42: 350–366.
- Traeger, A.C., Moynihan, R.,Maher, C.G. (2017). Wise choices: making physiotherapy care more valuable. Journal of Physiotherapy, 63(2): 63-65
- Degeling, C., Barratt, A., Aranda, S., Bell, R., Doust, J.,Houssami, N., Hersch, J., Sakowsky, R., Entwistle, V. and Carter, S.M., 2018. Should women aged 70–74 be invited to participate in screening mammography? A report on two Australian community juries. BMJ open, 8(6): p.e021174.
- Nickel, B., Barratt, A., McGeechan, K., Brito, J. P., Moynihan, R.,Howard, K., & McCaffery, K. (2018). Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial. JAMA Otolaryngology – Head and Neck Surgery, 144(10): 867-875
- Moynihan, R.,Barratt, A.L., Buchbinder, R., Carter, S.M., Dakin, T., Donovan, J., Elshaug, A.G., Glasziou, P.P., Maher, C.G., McCaffery, K.J. and Scott, I.A., 2018. Australia is responding to the complex challenge of overdiagnosis. Medical Journal of Australia, 209(8): 332-334.
- Moynihan, R., Nickel, J. Hersch,J. Doust, A. Barratt, E. Beller, K. McCaffery (2015). What do you think overdiagnosis means? A qualitative analysis of responses from a national community survey of Australians. BMJ open, 5(5): e007436.
- Moynihan, R., Nickel, J. Hersch, E. Beller, J. Doust,S. Compton, A. Barratt, L. Bero, K. McCaffery (2015). Public Opinions about Overdiagnosis: A National Community Survey. PLoS ONE, 10(5): e0125165
- McCaffery, K.J, Jansen, J.,Scherer, L.D., Thornton, H., Hersch, J., Carter, S.M., Barratt, A., Sheridan, S., Moynihan, R.,Waller, J., Brodersen, J., Pickles, K., Edwards, A. (2016) Walking the tightrope: communicating overdiagnosis in modern healthcare. BMJ, 352: i348
- Johansson, M., Jørgensen, K.J., Getz, L., Moynihan, R.(2016). “Informed choice” in a time of too much medicine—no panacea for ethical difficulties. BMJ, 353: i2230
- Moynihan, R.(2016). Preventing overdiagnosis–winding back the harms of too much medicine. Port J Nephrol Hypert, 30(1), 14-15.
- Moynihan, R.,Sims, R., Hersch, J., Thomas, R., Glasziou, P.P., McCaffery, K. (2017). Communicating about overdiagnosis: Learning from community focus groups on osteoporosis. PLoS One, 12(2): e0170142
- Medew, J., Moynihan, R.(2017). Improving coverage of medical research in a changing media environment. CMAJ, 189(15): E551-E552.
- Nickel, B., Barratt, A., Copp, T., Moynihan, R.,McCaffery, K., 2017. Words do matter: a systematic review on how different terminology for the same condition influences management preferences. BMJ open, 7(7): p.e014129.
- Copp, T., Jansen, J., Doust, J.,Mol, B.W., Dokras, A., McCaffery, K., 2017. Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome? BMJ, 358: j3694.
- Nickel, B., Brito, J.P., Moynihan, R.,Barratt, A., Jordan, S. and McCaffery, K., 2018. Patients’ experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study. BMC cancer, 18(1): 242.
- Bonner, C., McKinn, S., Lau, A., Jansen, J., Doust, J.,Trevena, L. and McCaffery, K., 2018. Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?. Patient Education and Counseling, 101(5): 843-853
- Nickel, B., Moynihan, R.,Barratt, A., Brito, J. P., & McCaffery, K. (2018). Renaming low risk conditions labelled as cancer. BMJ, 362: k3322
- Nickel, B., Howard, K., Brito, J.P., Barratt, A.,Moynihan, R.,McCaffery, K., 2018. Association of Preferences for Papillary Thyroid Cancer Treatment With Disease Terminology: A Discrete Choice Experiment. JAMA Otolaryngol Head Neck Surg, 144(10): 887-896
- Moynihan, R.N., Clark, J. and Albarqouni, L., 2018. Media Coverage of the Benefits and Harms of the 2017 Expanded Definition of High Blood Pressure. JAMA Intern Med, doi:10.1001/jamainternmed.2018.6201
- Barratt, A., Irwig, L. and Glasziou, P.(2015), A novel case-control design to estimate the extent of over-diagnosis of breast cancer due to organised population-based mammography screening. J. Cancer, 136: 2486.
- Jacklyn, G., McGeechan, K., Houssami, N., Bell, K.,Glasziou, P.P. and Barratt, A., 2018. Overdiagnosis due to screening mammography for women aged 40 years and over.Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD013076
Prof Alex Barratt (University of Sydney)
Prof Rachelle Buchbinder (Monash University)
Prof Stacy Carter (University of Wollongong)
Prof Adam Elshaug (University of Sydney)
Prof Kirsten Howard (University of Sydney)
Prof Ian Kerridge (University of Sydney)
Prof Chris Maher (University of Sydney)
Prof Kirsten McCaffery (University of Sydney)
Prof Chris Semsarian (University of Sydney)
Our current grants
- NHMRC Program Grant: Using Healthcare Wisely: Reducing inappropriate use of tests and treatments; $9,578,895.00 (1/1/17-31/12/21)
- NHMRC Centre for Research Excellence Grant: Creating sustainable healthcare: ensuring new diagnostics avoid harms, improve outcomes, and direct resources wisely; $2,497,658.00 (1/5/16-30/4/21)
- NHMRC Fellowship: Dr Ray Moynihan: Preventing Overdiagnosis: A research programme to investigate and respond to the health impacts of expanding disease definitions and lowering diagnostic thresholds; $318,768.00 (1/3/17-28/2/22)
Luise Kazda (University of sydney)