BMJ - Citizens’ juries can bring public voices on overdiagnosis into policy making

Y

Yessica

Senior Member (Voting Rights)
Hi, Mods. Please feel free to move to a better place, wasn't sure where to post this. Thank you.



https://www.bmj.com/content/364/bmj.l351

As practitioners and policy makers struggle to manage the risks and harms of overdiagnosis, Chris Degeling and colleagues contend that citizens’ juries offer a way forward

Key messages
  • Overdiagnosis challenges the social contract that underpins healthcare, and community voices are often missing from the relevant policy discussions

  • Citizens’ juries elicit the voices, values, and preferences of informed citizens who are presented with evidence based expert views

  • Jurors deliberate the evidence among themselves before formulating their opinions and recommendations

  • Citizens’ juries can elucidate public values that can then be used to inform policies and practices to manage the risks of overdiagnosis

  • The findings can contribute to guideline development and proposed changes to disease thresholds

  • The process of citizens’ juries align with the basic tenets of evidence based medicine and can broaden and improve the dialogue around medical uncertainty
Unnecessary and harmful interventions from overdiagnosis challenge the social and ethical contract that underpins healthcare.12

Strategies to tackle overdiagnosis from population screening should engage with the public and consider its values and concerns.3

Most high income countries develop evidence based policies to guide population screening using stringent criteria that are applied by expert panels to review the available technical evidence. Similarly, if perhaps not so systematically, expert panels collect and analyse pathophysiological and clinical evidence to determine disease thresholds and definitions.4

But in both cases the final judgments on the acceptability and legitimacy of different screening policies and disease definitions are informed by the values of the decision makers, because the relative balance of harms and benefits of making changes are also subjectively weighed and valued.567

For the deliberation sponsors (researchers, government, or other agencies), putting matters to the public can promote greater social and political engagement, public accountability, and confidence in the decision ultimately made.

Public engagement …

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PS, I think the concern originally stems from diagnosing "pre-diabetes" and getting too many mammograms*, and also high blood pressure, and screening for thyroid cancer, but a strong focus on avoiding overdiagnosis probably has an effect on people not getting diagnosed, especially if they don't have an obvious presentation of a well-known disease.

*[NB: the screenings may not be causing the cancers, as the video implies--most people have about 100 cancers that their immune system is able to handle; so the increase in small cancers probably contains a lot that didn't need treatment... but screenings often use ionizing radiation, so it's possible]
 
This seems to be saying:

'If you have some bee in your bonnet about medical policy and don't like what the experts say, why not some of those dumb ordinary people to back you up?'

There was a guy called Trump who preferred guns to abortion who did that.

And in both scenarios the agenda was really being driven by others' financial interests.
 
Thanks. Lots of good points. I'm was too foggy to read the article in detail.

What was on my mind is all the suffering and loss due to overdiagnosis/misdiagnosis of psych.

I was wondering if we could get rid of the overdiagnosis of psych then we could actually get to a diagnosis for lots of people or not be thrown into a harmful wastebasket of a psych condition that one does not have.

Do you think this can be useful to help with the overdiagnosis of depression, anxiety. psychosmatic and other psych? So practitioners would dig deeper and find the medical diagnosis or admit that science does not know all.

Probably we all have known people and many of us who have had serious testable and treatable medical things going on yet we are quickly diagnosed as or written off as a psych condition.

Getting rid of the overdiagnosis of psych would help all patients and our community tremendously. This has been on my mind for years even more so with each loss and all the suffering in our community and with hearing last year all that one of our beloved community member went through the last several months of his life due to this.
 
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