Précising definitions as a way to combat overdiagnosis

Area of Science:

• Medical Ethics
• Philosophy of Medicine
• Clinical Diagnostics

Background:

• Overdiagnosis (ODx) is a significant problem where individuals receive diagnoses and treatments that offer no benefit and may cause harm.
• The vague definition of disease contributes to the issue of overdiagnosis.
• Existing disease definitions lack precision, leading to potential harm from unnecessary medical interventions.

Purpose of the Study:

• To develop a precise definition of disease to prevent overdiagnosis and associated harms.
• Introduce disease_ODx, a stipulative definition to differentiate beneficial diagnoses from harmful ones.
• Provide a framework for distinguishing between conditions requiring intervention and those that do not.

Main Methods:

• Examined the concepts of dysfunction, comparative harm, and risk within the context of disease.
• Utilized a naturalistic account of biological function.
• Applied a Feinbergian framework for assessing comparative harm.
• Incorporated a probabilistic understanding of risk assessment.

Main Results:

• Proposed a preliminary definition: X is a disease_ODx if there is dysfunction with a significant risk of causing severe harm.
• The proposed definition aims to distinguish between diagnoses that benefit patients and those that are more likely to cause harm.
• The utility of the disease_ODx definition was tested using examples of overdiagnosed clinical conditions.

Conclusions:

• The proposed disease_ODx definition offers a practical approach to mitigating overdiagnosis.
• This refined definition can guide clinical decision-making, reducing unnecessary interventions.
• Further application and testing of the disease_ODx concept are warranted in clinical practice.