Overdiagnosis: when good intentions meet vested interests


Iona HeathOverdiagnosis: when good intentions meet vested interests—an essay by Iona Heath does not mention accreditation.  It’s about the financial interests that have led to overdiagnosis and overtreatment.  When you read the essay, you’ll have to substitute “UKAS assessment” for the various patient screening measures that she has written about.  You will see that the criticisms applied to clinical testing can usually be applied to the screening of work performance by the likes of UKAS.

“Underpinned by webs of financial imperatives and conflicted interests, overdiagnosis and overtreatment have become disturbingly pervasive within contemporary medicine and are now deeply embedded within healthcare systems around the world. They have permeated and polluted the drug and medical technology industries, medical research and regulatory bodies, clinical practice, payment systems, guideline production, and national healthcare systems. They are the cause of an astonishing amount of waste and harm.

“The main engine is the medical technology industry, which enables healthcare professionals to investigate more and more minutely and to measure and assign numbers to an ever increasing number of biometric parameters. These numbers are almost always normally distributed along a continuum, with one extreme representing a degree of abnormality that begins to correlate with symptoms and suffering that can be ameliorated or cured by medical treatment. So far, so good. The problem is that a toxic combination of vested interest and good intentions produces continual pressure to extend the range of abnormal, shifting the demarcation point further into the territory previously considered normal. This is encouraged by entrenched belief in such old adages as “prevention is better than cure” and “a stitch in time saves nine.” These ancient sayings are imbibed at such a young age that they seem to assume an almost mythological aura of truth, and we have neglected the popperian imperative of investigating why they might be wrong.”

This leads to a symptomless epidemic that results in “extending the definitions of disease and lowering the thresholds for preventive interventions [that] create the illusion of improved population outcomes, while there is no difference at all in the outcomes for affected individuals.”  Just as the screening test of laboratory inspection finds issues that have no impact on patients.  Only standardisation is acceptable.  Everything else is non-compliance and therefore has failed to have quality inspected into it. 

The author quotes Frankfurt School theorist, Herbert Marcuse, on the technical-economic co-ordination of vested interests.  UKAS and the DTI collude on the economic-technical axis as much as US healthcare companies buy government ministers in the hope of growing their market share in the UK.  Heath observes from Orwell’s 1984 the danger of great power when it is, by totalitarianism, freed from conditions that should permit individual decisions in different situations. 

“We are developing a culture of conformity which pays lip service to autonomy and choice but within which the individual is only really free to make the choice that is approved by the state…”

“It has become difficult to question the means because the end of curing and preventing disease is so obviously worthy. Nonetheless, the means are damaging not least because they are so unidimensional and propagate an intensely normative view of what it means to be healthy and indeed what human life should be.”

Anyone who reads the Barnes Pathology Quality Assurance Review and what UKAS has to say about it should read Heath’s essay also.  Pathologists are so busy complying they have not been able to take time and compare what they are doing with the mistakes of other screening programmes.

Just scrap accreditation.  Where’s the evidence that it does any good?

 

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