• primary care

In their paper, Ray Moynihan and colleagues1 analyse the problems of disease thresholds and their impact on expanding disease definitions, overdiagnosis, overtreatment and wasted resources. The group calls for a new approach to developing disease definitions that includes being primary care led, people-centred, independent of commercial interests and informed by better guidelines.

The authors highlight several concerns with the current approach to disease definitions. For example, approximately half of the older population are defined as having chronic kidney disease, yet many are asymptomatic with no negative impact on their day-to-day living. New thresholds for gestational diabetes have meant the prevalence has doubled, without a clear indication of the outcomes that may be affected. Furthermore, new hypertension guidelines have labelled half of the adult population as hypertensive. Changing definitions place a considerable burden on patients and an overly stretched healthcare system that is required to manage these ‘phantom conditions’.

Primary care is likely to be …