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Primary care
Redefining disease definitions and preventing overdiagnosis: time to re-evaluate our priorities
  1. Carl Heneghan1,
  2. Kamal R Mahtani2
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; carl.heneghan{at}

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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 …

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  • Contributors CH wrote the first draft and KM contributed subsequent drafts.

  • Competing interests CH and KRM are supported by the NIHR School for Primary Care Research Evidence Synthesis Working group (NIHR SPCR ESWG project 390). CH is Director of CEBM and also supported by the NIHR Oxford Biomedical Research Centre, is an NIHR Senior Investigator and Editor-in-Chief of BMJ Evidence-Based Medicine. KRM is an Associate Editor of BMJ EBM. CEBM jointly runs the EvidenceLive Conference with the BMJ and the Preventing Overdiagnosis Conference with international partners based on a non-profit making model.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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