The Impact of Definitions of Disease on Overdiagnosis, 2025, Tikkinen/Halme/Guyatt/Glasziou

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The Impact of Definitions of Disease on Overdiagnosis​

Kari A. O. Tikkinen, MD, PhD1,2,3,4; Alex L. E. Halme, BSc1; Gordon H. Guyatt, MD4,5; et al Paul Glasziou, MD, PhD6
Author Affiliations
  • 1Faculty of Medicine, University of Helsinki, Helsinki, Finland
  • 2Department of Urology, University of Helsinki and University Hospital, Helsinki, Finland
  • 3Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
  • 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  • 5Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  • 6Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia

JAMA Intern Med
Published Online: June 9, 2025
doi: 10.1001/jamainternmed.2025.1727




The concept and definition of disease influences both clinical practice and public health. The World Health Organization has defined health but failed to define disease. The contemporary concept of disease emerges from biology but is influenced by social, cultural, and economic factors. Definitions are important, as how we label a condition can determine how society perceives, manages, and supports patients. Continuously expanding disease criteria can reduce underdiagnosis and increase appropriate care, but often risk overdiagnosis, resulting in overtreatment and low-value care, ultimately threatening health care sustainability.
 
I'm frankly not the least bit interested in the blathering of Glasziou, but I can't see this any other way than just foolish reactionary "the only valid things are those that existed when I learned about them in school, and everything after that is useless and stupid". It's the exact same problem attitude so many people have about the world, imagining that things "used to be so much better back then". Back then, when they were kids, who didn't know anything about the world. :rolleyes:

I see this attitude everywhere in medicine. How so many things are being over-diagnosed, when in fact most of things used to be massively under-diagnosed, but to them the only valid quantity of it is the one they first learned about, a fact that should be set in stone and never, ever, for any reason, be changed. As if only serious things that are life-changing should ever be diagnosed, which is completely silly. It's as if they don't want to know things, would rather cover up reality to make them feel better about it. Feels like a church more than a profession to me.

Medicine is way too conservative, reactionary at times. This is crippling its ability to perform and grow. And frankly most health care professionals should stick to biology, and leave philosophy to people who are trained, and capable, at it. It's just not their thing, medical training absolutely does not translate well there. Or anywhere else, frankly. It's far too narrow in scope to be of relevance anywhere else.
 
A sentence from it:
New diseases may arise, for example, from new causes (COVID-19), advances in diagnostic technologies (early-stage cancers), or conscious advocacy (chronic fatigue syndrome)
 
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