Post by itchin4answers on May 26, 2011 3:53:27 GMT -5
The need for new ways to define disease
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In a series of articles in the British Medical Journal Australian medical journalist Ray Moynihan argues that there are problems in the way diseases are defined.
SHOW TRANSCRIPT
www.abc.net.au/rn/healthreport/stories/2011/3222361.htm
Medicalisation - A new deal on disease definition
Ray Moynihan, author, journalist, and conjoint lecturer
How do we replace the old panels of conflicted experts? Ray Moynihan investigates
As this still-fresh century rolls forth, medicine’s imperial project looks on the whole to be in remarkably good health, despite the odd failed campaign. With our new found fondness for preventing disease and premature death we’re redefining more and more of the healthy as sick, and then prescribing our new patients lifelong pharmaceutical solutions to reduce their risks. One recent analysis suggests that the definitions of common conditions have broadened so much that virtually the entire older adult population is now classified as having at least one chronic disease.1
Yet a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit.2 It has also become clear that many of the people on the panels that are widening the patient pool have direct financial ties to the companies benefiting from that expansion. Concerns are mounting that doctors are collectively overdiagnosing millions of what were until very recently considered healthy people, and leading voices are asking whether it is time society at large took a more direct role in deciding who really warrants a medical label.3 Some are now calling for a major renovation of the way in which we define disease.
Conflicted panels widen diseases, lower treatment thresholds
Among the 12 members of the panel that created the controversial diagnostic category “pre-hypertension” in 2003, 11 received money from drug companies, and half of those people declared extensive ties to more than 10 companies each.4 Critics have rejected “pre-hypertension” as a dangerous pseudo-syndrome that could increase drug company markets,5 while others point out that it gives a diagnostic label to nearly 60% of the adult population of the United States.1 Similarly, 11 of the 12 authors of a 2009 statement on type 2 diabetes were heavily conflicted, with authors working as consultants, speakers, or researchers for an average of nine companies each.6 That panel advocated a contentiously low blood sugar target, and explicitly defended the use of rosiglitazone, a drug since suspended from the European market because of its hazards to human health. Within the field of sexual dysfunction, conflicts of interest have reached new heights of absurdity, with drug company employees joining their paid consultants to design diagnostic tools to identify and then medicate millions of women with a disorder of low desire that may not even exist. 7 8
One of the best known examples of conflicted panels widening disease definitions comes from the Diagnostic and Statistical Manual of Mental Disorders. An examination of those who produced its fourth edition found 56% of panel members had financial ties to drug companies, although for some panels, including that for mood disorders, the figure was 100%.9 Despite a new American Psychiatric Association policy aimed at reducing conflicts, an analysis of the forthcoming fifth edition found that of those panel members who’d made disclosure statements, exactly 56% had financial relationships with pharmaceutical companies.10
“We’ve got to take this away from the American Psychiatric Association,” said Allen Frances, the psychiatrist who chaired the taskforce for the fourth edition, the DSM-IV. He now believes that that edition unwittingly contributed to an explosion of unnecessary diagnoses in the areas of attention deficit, autism, and bipolar disorder. Frances argued that it was not just financial ties that were important, but intellectual conflicts too, where researchers pushed for greater recognition of their own pet conditions. To emphasise this point, he said that he did not believe a drug industry push was behind even those decisions that would most benefit the industry. Today he warns that the forthcoming DSM-V could unleash multiple new “false positive epidemics,” where common experiences including binge eating and temper problems are mistaken for the “symptoms” of new disorders.11 “Experts tend to loathe the idea of missing a potential patient, and they lack the ability to assess the risks and benefits of creating new conditions or widening old ones,” he explained to the BMJ. “This sort of work should no longer be done by any professional association. A new way to define disease is needed.”
Summary points
Many existing panels that define and expand diseases are heavily tied to drug companies
Some voices are calling for fresh new ways to define disease, with new panels
New panels could be independent of industry and entirely free of conflicts of interest
The constitution of new panels could be broadened, more representative, with more citizens’ voices
The best evidence should inform decisions, including evidence on social determinants[/b]
Full Text Article: www.bmj.com/content/342/bmj.d2548.full?keytype=ref&ijkey=6pXberf82XwzLlM
LISTEN NOW DOWNLOAD AUDIO
In a series of articles in the British Medical Journal Australian medical journalist Ray Moynihan argues that there are problems in the way diseases are defined.
SHOW TRANSCRIPT
www.abc.net.au/rn/healthreport/stories/2011/3222361.htm
Medicalisation - A new deal on disease definition
Ray Moynihan, author, journalist, and conjoint lecturer
How do we replace the old panels of conflicted experts? Ray Moynihan investigates
As this still-fresh century rolls forth, medicine’s imperial project looks on the whole to be in remarkably good health, despite the odd failed campaign. With our new found fondness for preventing disease and premature death we’re redefining more and more of the healthy as sick, and then prescribing our new patients lifelong pharmaceutical solutions to reduce their risks. One recent analysis suggests that the definitions of common conditions have broadened so much that virtually the entire older adult population is now classified as having at least one chronic disease.1
Yet a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit.2 It has also become clear that many of the people on the panels that are widening the patient pool have direct financial ties to the companies benefiting from that expansion. Concerns are mounting that doctors are collectively overdiagnosing millions of what were until very recently considered healthy people, and leading voices are asking whether it is time society at large took a more direct role in deciding who really warrants a medical label.3 Some are now calling for a major renovation of the way in which we define disease.
Conflicted panels widen diseases, lower treatment thresholds
Among the 12 members of the panel that created the controversial diagnostic category “pre-hypertension” in 2003, 11 received money from drug companies, and half of those people declared extensive ties to more than 10 companies each.4 Critics have rejected “pre-hypertension” as a dangerous pseudo-syndrome that could increase drug company markets,5 while others point out that it gives a diagnostic label to nearly 60% of the adult population of the United States.1 Similarly, 11 of the 12 authors of a 2009 statement on type 2 diabetes were heavily conflicted, with authors working as consultants, speakers, or researchers for an average of nine companies each.6 That panel advocated a contentiously low blood sugar target, and explicitly defended the use of rosiglitazone, a drug since suspended from the European market because of its hazards to human health. Within the field of sexual dysfunction, conflicts of interest have reached new heights of absurdity, with drug company employees joining their paid consultants to design diagnostic tools to identify and then medicate millions of women with a disorder of low desire that may not even exist. 7 8
One of the best known examples of conflicted panels widening disease definitions comes from the Diagnostic and Statistical Manual of Mental Disorders. An examination of those who produced its fourth edition found 56% of panel members had financial ties to drug companies, although for some panels, including that for mood disorders, the figure was 100%.9 Despite a new American Psychiatric Association policy aimed at reducing conflicts, an analysis of the forthcoming fifth edition found that of those panel members who’d made disclosure statements, exactly 56% had financial relationships with pharmaceutical companies.10
“We’ve got to take this away from the American Psychiatric Association,” said Allen Frances, the psychiatrist who chaired the taskforce for the fourth edition, the DSM-IV. He now believes that that edition unwittingly contributed to an explosion of unnecessary diagnoses in the areas of attention deficit, autism, and bipolar disorder. Frances argued that it was not just financial ties that were important, but intellectual conflicts too, where researchers pushed for greater recognition of their own pet conditions. To emphasise this point, he said that he did not believe a drug industry push was behind even those decisions that would most benefit the industry. Today he warns that the forthcoming DSM-V could unleash multiple new “false positive epidemics,” where common experiences including binge eating and temper problems are mistaken for the “symptoms” of new disorders.11 “Experts tend to loathe the idea of missing a potential patient, and they lack the ability to assess the risks and benefits of creating new conditions or widening old ones,” he explained to the BMJ. “This sort of work should no longer be done by any professional association. A new way to define disease is needed.”
Summary points
Many existing panels that define and expand diseases are heavily tied to drug companies
Some voices are calling for fresh new ways to define disease, with new panels
New panels could be independent of industry and entirely free of conflicts of interest
The constitution of new panels could be broadened, more representative, with more citizens’ voices
The best evidence should inform decisions, including evidence on social determinants[/b]
Full Text Article: www.bmj.com/content/342/bmj.d2548.full?keytype=ref&ijkey=6pXberf82XwzLlM