Précising definitions as a way to combat overdiagnosis

Wendy A. Rogers, Mary J. Walker

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or précising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this diseaseODx, aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of diseaseODx is that X is a diseaseODx iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.

LanguageEnglish
Pages1019-1025
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Volume24
Issue number5
Early online date30 Mar 2018
DOIs
Publication statusPublished - Oct 2018

Fingerprint

Health
Medical Overuse

Bibliographical note

Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • diagnosis
  • philosophy of medicine
  • overdiagnosis

Cite this

@article{7736a57733894d7ba17a2038f19903fd,
title = "Pr{\'e}cising definitions as a way to combat overdiagnosis",
abstract = "Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or pr{\'e}cising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this diseaseODx, aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of diseaseODx is that X is a diseaseODx iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.",
keywords = "diagnosis, philosophy of medicine, overdiagnosis",
author = "Rogers, {Wendy A.} and Walker, {Mary J.}",
note = "Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
year = "2018",
month = "10",
doi = "10.1111/jep.12909",
language = "English",
volume = "24",
pages = "1019--1025",
journal = "Journal of Evaluation in Clinical Practice",
issn = "1356-1294",
publisher = "Wiley-Blackwell, Wiley",
number = "5",

}

Précising definitions as a way to combat overdiagnosis. / Rogers, Wendy A.; Walker, Mary J.

In: Journal of Evaluation in Clinical Practice, Vol. 24, No. 5, 10.2018, p. 1019-1025.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Précising definitions as a way to combat overdiagnosis

AU - Rogers, Wendy A.

AU - Walker, Mary J.

N1 - Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2018/10

Y1 - 2018/10

N2 - Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or précising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this diseaseODx, aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of diseaseODx is that X is a diseaseODx iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.

AB - Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or précising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this diseaseODx, aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of diseaseODx is that X is a diseaseODx iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.

KW - diagnosis

KW - philosophy of medicine

KW - overdiagnosis

UR - http://www.scopus.com/inward/record.url?scp=85044584224&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/arc/FT130100346

U2 - 10.1111/jep.12909

DO - 10.1111/jep.12909

M3 - Article

VL - 24

SP - 1019

EP - 1025

JO - Journal of Evaluation in Clinical Practice

T2 - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

SN - 1356-1294

IS - 5

ER -