Justification and interest of the workshop A challenge with the approach of Evidence-based Medicine (EBM) is the current ability to reduce but not to prevent overdiagnosis. Three different examples of this challenge will be introduced:
Risk factors The case of UK’s National Institute for Health and Care Excellence updated draft guidance for the diagnosis and management of hypertension in adults. The guidance is not evidence based and will increase overdiagnosis. However, do the principles of current EBM prevent any increased health risk to become a disease as long as it is supported by evidence of a positive treatment effect?
Existential conditions The case of the newly assigned ICD-10 diagnosis Sarcopenia, which is an age-related loss of muscle mass and function. Evidence supports strong associations between sarcopenia and multiple health-related conditions e.g. frailty, cardiac and respiratory diseases, cognitive impairment, low quality of life and death. However, the associations are obvious when natural parts of life have been medicalised. Does EBM prevent this?
Medical screening Colorectal cancer (CRC) screening with faecal occult blood test (iFOBT) has shown a disease-specific relative mortality reduction, which could justify the CRC screening programme’s existence according to EBM. However, almost 50% of all positive screenees are (over)diagnosed with colorectal polyps. How does EBM assess the different ontology of technical measurements and phenotypical/phenomenological diseases, when the aim is to prevent diseases without medicalising any surrogate measure?
To learn about specific, clinical cases where current EBM is insufficient to prevent overdiagnosis.
To learn what these cases have in common, thereby suggesting focus for future improvement of EBM.
Methods The three cases will be presented, including our suggestions of reasons in EBM principles that facilitate overdiagnosis.
Small group discussions will afterwards discuss: 1) other perspectives on these cases, 2) other potential cases, 3) overall principles that all cases have in common.
Finally, a plenum discussion will share the thoughts and perspectives from the group discussion topics.
Expected impact on the participant By sharing knowledge and experiences, participants are expected to increase their knowledge about limitations of EBM regarding overdiagnosis and stimulate new ideas and thoughts for future research projects.
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