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Primary care
Reforming disease definitions: a new primary care led, people-centred approach
  1. Ray Moynihan1,
  2. John Brodersen2,
  3. Iona Heath3,
  4. Minna Johansson4,
  5. Thomas Kuehlein5,
  6. Sergio Minué-Lorenzo6,
  7. Halfdan Petursson7,
  8. Miguel Pizzanelli8,
  9. Susanne Reventlow2,
  10. Johann Sigurdsson9,
  11. Anna Stavdal10,
  12. Julian Treadwell11,
  13. Paul Glasziou12
  1. 1 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
  2. 2 University of Copenhagen, Copenhagen, Denmark
  3. 3 Royal College of General Practitioners, London, UK
  4. 4 Cochrane Sweden, Lund, Sweden
  5. 5 Universitätsklinikum Erlangen, Erlangen, Germany
  6. 6 Andalusian School of Public Health, Granada, Spain
  7. 7 Norwegian University of Science and Technology, Trondheim, Norway
  8. 8 Universidad de la República de Uruguay, Montevideo, Uruguay
  9. 9 Nordic Federation of General Practice, Trondheim, Norway
  10. 10 Wonca World, Oslo, Norway
  11. 11 University of Oxford, Oxford, UK
  12. 12 Centre for Research in Evidence-Based Practice (crebp.net.au), Robina, Queensland, Australia
  1. Correspondence to Dr Ray Moynihan, Centre for Research in Evidence-Based Practice, Bond University, Gold Coast QLD 4229, Australia; raymoynihan{at}bond.edu.au

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Abstract

Expanding disease definitions are causing more and more previously healthy people to be labelled as diseased, contributing to the problem of overdiagnosis and related overtreatment. Often the specialist guideline panels which expand definitions have close tis to industry and do not investigate the harms of defining more people as sick. Responding to growing calls to address these problems, an international group of leading researchers and clinicians is proposing a new way to set diagnostic thresholds and mark the boundaries of condition definitions, to try to tackle a key driver of overdiagnosis and overtreatment. The group proposes new evidence-informed principles, with new process and new people constituting new multi-disciplinary panels, free from financial conflicts of interest.

Introduction

Expanding definitions of disease are causing too many people to be diagnosed and treated unnecessarily, producing harm and waste, posing a major threat to human health and the sustainability of health systems, and creating growing conflict within medicine.1 2 For example, the widely used definition of ‘chronic kidney disease’ labels around half of all older people, yet many of them will never experience related symptoms.3 Changes to the definition of gestational diabetes could double its prevalence, despite a lack of clear evidence that the expansion will bring the newly diagnosed meaningful benefits that outweigh harms.4 Recently, a new definition of hypertension which labels one in every two adults, while welcomed by some, has been soundly rejected by family doctors over concerns it may cause more harm than good to many people.5 Responding to growing calls for action to address this key driver of overdiagnosis, from professional societies and other groups around the globe,2 6 7 we are proposing a new primary care-led, multidisciplinary, independent, people-centred approach to defining disease.

The unmet need for reform

An ongoing series about overdiagnosis in the BMJ has documented global …

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