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Global push to reform the way we define disease

Photo: Global push to reform the way we define disease
Experts release new rules for panels which seek to make more healthy people into patients

A group of international experts today released the first ever guidance for medical panels which make changes to disease definitions, in a landmark paper in the prestigious journal JAMA Internal Medicine.

The international group came together because of growing awareness that medical panels are regularly widening disease definitions, labelling more and more of the healthy population as sick.

Recent examples covered in the paper include:
  • Dramatic increases in the number of older women eligible for drug treatment for the bone condition osteoporosis
  • Creation of the new ‘pre-diabetes’ label, claimed to affect more than one-third of all adults, and about half the population of China.
The group, including a representative from the WHO, was brought together by the international Guidelines International Network, and was led by Professor Jenny Doust, at Bond University in Australia.

“Our research suggests panels of experts frequently widen definitions without rigorously assessing the numbers of people affected or the potential harms – as well as the benefits – of the changes,” Professor Doust said.

“Harms can be because the expected benefits of a label are overestimated in the wider group. This can lead to overtreatment, causing harm to those diagnosed.

“It can also divert resources to those with milder problems and make it harder for patients with more severe disease to get access to the care that they need.”

A previous study also found that panels which change disease definitions have a majority of members with extensive ties to pharmaceutical companies with an interest in those decisions.

The JAMA Internal Medicine article points to growing evidence that widening disease definitions is driving overdiagnosis and overtreatment across a range of conditions.

“Disease definitions should be modified only when there is strong evidence of benefit,” Professor Doust said.

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