DOCSLIB.ORG

Preventing Overdiagnosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Preventing Overdiagnosis Bond University DOCTORAL THESIS Preventing Overdiagnosis Moynihan, Raymond Award date: 2016 Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. Preventing Overdiagnosis A thesis submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy Raymond Noel Moynihan Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Australia February 2015 Preventing Overdiagnosis 2 Preventing Overdiagnosis Summary Background Medicine’s ability to help the sick is being challenged by its propensity to harm the healthy. As part of broader evidence and concern about too much medicine,[1] overdiagnosis is being increasingly recognised as a cause of harm and waste.[2] Overdiagnosis occurs when people are diagnosed with a disease that won’t harm them, commonly as a result of screening programmes detecting non-progressive diseases, such as indolent cancers. More broadly defined, overdiagnosis happens when expanding disease definitions label more people with milder symptoms or at lower risks, for whom a label and treatment may do more harm than good. Aims The thesis aimed to research the nature and causes of overdiagnosis, the mechanisms by which disease definitions are expanding, public awareness of overdiagnosis, and possible policy responses. Methods Several different methods were employed for a range of related research. An initial scoping of the literature was undertaken to prepare an overview. A cross-sectional study investigated how influential expert panels were changing definitions of common conditions. Arising from the scoping and the study, chronic kidney disease was selected and examined according to an explicit template, to learn more about how controversial definitions are expanded and defended. A questionnaire was developed and piloted, and a national quantitative survey conducted. A qualitative study analysed themes emerging from community responses to an open-ended question about the meaning of overdiagnosis. Results The initial literature scoping identified considerable evidence for overdiagnosis and potential drivers.[3] The cross-sectional study found among 16 expert panel publications, 10 widened definitions, 1 narrowed, and for 5, it was unclear.[4] No panel reported on potential for overdiagnosis, and of those panels making disclosures, 75% of members had multiple financial ties to companies with direct interests in broadened patient populations, contrary to Institute of Medicine, IOM, recommendations.[5,6] The case study found against a backdrop of sustained criticism, the controversial expansion of chronic kidney disease was 3 Preventing Overdiagnosis repeatedly defended by conflicted experts.[7] The survey found a minority of respondents (10%) - including those screened for prostate,(18%) and breast cancer,(10%) - reported they’d been informed about overdiagnosis, and a majority(78%) felt it inappropriate disease- defining panels had ties to companies.[8] A qualitative analysis of responses to “what do you think the term overdiagnosis means?” found 40% of participants had approximate understandings, 24% thought it meant overuse, and none mentioned screening.[9] Discussion and Implications A greater sensitivity to the problem of overdiagnosis is required in running and reporting on primary studies of tests and treatments, the production of systematic reviews, and proposals to change disease definitions.[10] Findings of endemic conflicts in panels setting diagnostic thresholds, in direct contrast to IOM and public antipathy, suggest a need for more independent and representative panels, informed by evidence about benefits and potential harms, including overdiagnosis. Survey findings reinforce the need for more information about overdiagnosis, particularly with screening. Recommendations include: (i) synthesising existing overdiagnosis evidence into an accessible repository; (ii) further investigating expanding disease definitions; (iii) reforming disease definition processes; (iv) initiating new international collaborations to further understand and combat overdiagnosis. References for Summary 1. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine: too little care. BMJ. 347:f4247. doi: 10.1136/bmj.f4247 2. Welch G, Schwartz L, Woloshin S. Overdiagnosed: making people sick in pursuit of health. Boston: Beacon Press; 2011. 3. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502. 4. Moynihan RN, Cooke GP, Doust JA, Bero L, Hill S, Glasziou P. Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Med. 2013;10:e1001500. doi: 10.1371/journal.pmed.1001500 5. Lo B, Field MJ. Conflict of interest in medical research, education, and practice. (Summary). Washington (D.C.): Institute of Medicine National Academies of Science; 2009 6. IOM. (Institute of Medicine) Clinical practice guidelines we can trust. Washington (D.C.): The National Academies Press; 2011 4 Preventing Overdiagnosis 7. Moynihan R, Glassock R, Doust J. Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased. BMJ. 2013;347:f4298. 8. Moynihan R, Nickel B, Hersch, J, Beller E, Doust J, Compton S, et al. Public opinions about overdiagnosis: a national community survey. In Press, PLOS ONE, May 20, 2015. 9. Moynihan R, Nickel B, Hersch J, Doust J, Barratt A, Beller E, McCaffery K. What do you think overdiagnosis means?: a qualitative analysis of responses from a national community survey of Australians. In Press, BMJ Open, 2015. 10. Moynihan R, Henry D, Moons KGM. Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much. PLoS Med. 2014;11(7): e1001655. doi:10.1371/journal.pmed.1001655 5 Preventing Overdiagnosis 6 Preventing Overdiagnosis Declaration and Addendum This thesis is submitted to Bond University in fulfilment of the requirements of the degree of Doctor of Philosophy. This thesis represents my own original work towards this research degree and contains no material which has been previously submitted for a degree or diploma at this University or any other institution, except where due acknowledgement is made. Ray Moynihan is the sole author on the Introduction and Discussion chapters, 1 and 8, and lead author on all other chapters, which are substantially unchanged multi-author papers. The original research work underpinning all chapters was driven in every case primarily by Ray Moynihan, who also produced initial drafts of each manuscript, and managed all aspects of the collaborative research projects. None of the work submitted in this thesis was carried out before the PhD candidature. All permissions to reproduce figures, graphs or illustrations are noted within chapters, and their numbering has been modified when aggregating published papers into the full length manuscript. Referencing is consistent with Vancouver style, and original references which appeared in the published papers have been slightly modified to reflect this. In a very small number of cases web links which were cited in references in the thesis published papers are no longer active. As per university rules, where a substantially unchanged multi-author paper is included in the thesis a statement appears at the end of the chapter outlining the contributions of all involved, and these statements have been signed by all authors. 7 Preventing Overdiagnosis 8 Preventing Overdiagnosis Acknowledgments Immeasurable gratitude is owed to my indefatigable supervisors, Paul Glasziou and Jenny Doust, who have been a constant source of inspiration, encouragement, collegiality and support through the development and delivery of this thesis. A special thank you goes to all my other colleagues at the Centre for Research in Evidence- Based Practice at Bond University, for their on-going enthusiasm for the thesis subject matter and their support and laughter, including, but not limited to, Chris Del Mar, Tammy Hoffmann, Rae Thomas, Elaine Beller, Chrissy Erueti and Sarah Thorning. I’d also like to acknowledge all the administrative, academic, management, library and other staff at Bond, who’ve helped facilitated my research, and helped make my time during the thesis so enjoyable and productive. I’m also indebted to colleagues, collaborators and friends who’ve offered advice, encouragement and guidance, including David Henry, Geoff Morgan, Alexandra Barratt, Kirsten McCaffery, Jolyn Hersch and Brooke Nickel. And finally, a very loving thank you to my partner Miranda Burne, for bearing with me through the running of this academic marathon, and to my new son Louis, for his smiles and laughter that helped to propel me across the finish line. 9 Preventing Overdiagnosis 10 Preventing Overdiagnosis Peer-reviewed journal articles arising from this thesis • Moynihan R, Doust J,
Load more

Recommended publications
  • Depression and Antidepressants in Australia and Beyond - a Critical Public Health Analysis Melissa Raven University of Wollongong
    University of Wollongong Research Online University of Wollongong Thesis Collection University of Wollongong Thesis Collections 2012 Depression and antidepressants in Australia and beyond - a critical public health analysis Melissa Raven University of Wollongong Recommended Citation Raven, Melissa, Depression and antidepressants in Australia and beyond - a critical public health analysis, Doctor of Philosophy thesis, Faculty of Arts, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3686 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Depression and antidepressants in Australia and beyond A critical public health analysis A thesis submitted in fulfilment of the requirements for the award of the degree Doctor of Philosophy from UNIVERSITY OF WOLLONGONG by Melissa Raven BA(Hons), MPsych(Clin), MMedSci(ClinEpid) Faculty of Arts 2012 ii Certification I, Melissa Raven, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy, in the Faculty of Arts, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Melissa Raven 5 July 2012 iii iv Concise table of contents List of acronyms .................................................................................... xiii Abstract ..................................................................................................
    [Show full text]
  • Overdiagnosis and Overtreatment Over Time
    University of Massachusetts Medical School eScholarship@UMMS Family Medicine and Community Health Publications and Presentations Family Medicine and Community Health 2015-6 Overdiagnosis and overtreatment over time Stephen A. Martin University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/fmch_articles Part of the Community Health and Preventive Medicine Commons, Diagnosis Commons, Family Medicine Commons, Preventive Medicine Commons, and the Primary Care Commons Repository Citation Martin SA, Podolsky SH, Greene JA. (2015). Overdiagnosis and overtreatment over time. Family Medicine and Community Health Publications and Presentations. https://doi.org/10.1515/dx-2014-0072. Retrieved from https://escholarship.umassmed.edu/fmch_articles/318 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Family Medicine and Community Health Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Diagnosis 2015; 2(2): 105–109 Opinion Paper Open Access Stephen A. Martin*, Scott H. Podolsky and Jeremy A. Greene Overdiagnosis and overtreatment over time Abstract: Overdiagnosis and overtreatment are often Introduction thought of as relatively recent phenomena, influenced by a contemporary combination of technology, speciali- In recent years, an increasing number of clinicians, jour- zation, payment models, marketing, and supply-related nalists, health service researchers, and policy-makers demand. Yet a quick glance at the historical record reveals have drawn attention to the problems of overdiagnosis that physicians and medical manufacturers have been and the overtreatment that it so often engenders [1, 2].
    [Show full text]
  • BOOKTIVISM: the Power of Words
    BOOKTIVISM: The Power of Words Book•ti•vi•sm(noun). 1. The mobilization of groups of concerned citizens produced by reading books offering powerful analyses of social or political issues. 2. A call to action based on the sharing of knowledge through books. 3. Books + activism = “booktivism.” 4. A term first used at the SellingSickness, 2013: People Before Profits conference in Washington, DC, see www.sellingsickness.com. Read. Discuss. Be thoughtful. Be committed. Here are some more suggestions to get you started: 1) Set up a reading group on disease-mongering among interested friends and colleagues. If you do The books included in BOOKTIVISM celebrate recent contributions to the broad topic of disease- not already have a group of interested readers, post a notice in your workplace, library, community mongering, especially as they examine the growing prevalence and consequences of overtreatment, center, apartment building, etc. Once you have a group, decide where to meet. Book clubs can overscreening, overmarketing, and overdiagnosis (see Lynn Payer’s 1992 classic, Disease-Mongers: How meet anywhere – at homes, in dorms, in pubs, in coffeehouses, at libraries, even online! Decide on Doctors, Drug Companies, and Insurers Are Making You Feel Sick, for an introduction to timing and format. Will you meet monthly/bimonthly? You’ll need time to prepare for the sessions, disease-mongering). but not so much time that you lose touch. Circulate the reading guide. It is usually best if one person leads each discussion, to have some questions at the ready and get things rolling. Although the challenge to disease-mongering is not unprecedented (the women’s health movement of the 1970s was another key historical moment), these books represent an impressive groundswell OR, maybe you’d like to of amazing, powerful, brilliant, and often deeply unsettling investigations by physicians, health scientists, 2) Set up a lecture/discussion group.
    [Show full text]
  • The Frail Elderly and Integral Health Management Centered on the Individual and the Family Editorial 307
    http://dx.doi.org/10.1590/1981-22562017020.170061 The frail elderly and integral health management centered on the individual and the family Editorial 307 The rapid aging of the Brazilian population, combined with an increase in longevity, has had serious consequences for the structure of health care networks, with an increased burden of chronic diseases and especially of functional disabilities. Unfortunately, the care offered to frail elderly people with multiple chronic health conditions, poly-disabilities or complex needs is fragmented, inefficient, ineffective and discontinuous, which can further harm their health. The hospital-based health system of the 19th and 20th centuries that is designed to deal with acute and especially infectious diseases is inadequate for meeting the needs of chronic patients for long-term, continuous treatment. The response of the health system to the new demands means the use of a set of management technologies that are capable of ensuring optimal standards of health care in a resolutive, efficient, scientifically structured manner, which is safe for patients and health professionals, timely, equitable, humanized and sustainable, is essential. The threefold goal of a better care experience, coupled with improved populational health and reduced costs developed by the Institute of Healthcare Improvement (Triple Aim), is the best strategy for reorganizing and optimizing health system performance. Providing the best care experience means understanding the particularities of health in the elderly. The use of parameters based on risk factors, diseases and/or age is inappropriate and is associated with a high risk of iatrogenic illness. Vitality is extremely heterogeneous among the elderly and chronological age is a precarious metric for the assessment of the homeostatic reserve of the individual.
    [Show full text]
  • Greenshield.Ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But It Can Mean More Harm
    AUGUST/SEPTEMBER 2019 Don’t miss episode 19 of our podcast as we discuss better approaches to health care with Dr. Danielle Martin, family physician, author, chief medical executive at Women’s College Hospital, and YouTube star. CLICK HERE TO LISTEN WHAT’S INSIDE MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH Page 2 WHAT’S UP... Drug pricing in the news Message of health care survey: evolve with the times Page 12 greenshield.ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But it can mean more harm Turns out that 60 really is the new 40—and even 80 is the new 60—as people worldwide are living longer. In fact, we can expect to live more than twice as long as our ancestors.1 So why then, if we are healthier and more active than ever, are more people becoming patients? It’s because health care is no longer considered just for the sick, it has expanded into also focusing on the well. At first blush, this may sound like a good thing; it may sound like prevention. But if your plan members are healthy—in that they don’t have health problems that need solving— health services may actually create problems. Problems like overdiagnosis and in turn, overtreatment—including all the anxiety, energy, time commitment, potential costs, and even physical harm that can come along with it. The controversy surrounding the medicalization of healthy people raises awareness of the difference between what is truly prevention versus what is just early diagnosis that may—or may not—be a good thing.
    [Show full text]
  • Results of the Self-Assessment of Essential Public Health Operations Foreword
    The WHO Regional The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Ministry of Health of the Kyrgyz Republic Armenia Austria Azerbaijan Belarus Belgium Results of the self-assessment of Bosnia and Herzegovina Bulgaria Croatia essential public health operations Cyprus Czechia in the Kyrgyz Republic Denmark Estonia Finland April–September 2016 France Georgia Germany Greece Bishkek 2017 Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Uzbekistan Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: [email protected] ABSTRACT This report presents the results of Kyrgyzstan’s self-assessment of the essential public health operations (EPHOs). The EPHO self-assessment was initiated by the Ministry of Health of the Kyrgyz Republic and conducted under the biennial collaborative agreement between the WHO Regional Office for Europe and the Government of Kyrgyzstan for 2016–2017. In addition to describing the assessment process, the technical report presents the key recommendations put forth by the Steering Committee and Specialized Teams. KEYWORDS ESSENTIAL PUBLIC HEALTH OPERATIONS HEALTH POLICY HEALTH SYSTEM PLANS – ORGANIZATION AND ADMINISTRATION HEALTH SYSTEM REFORM HEALTH SYSTEMS ASSESSMENT HEALTH SYSTEM STRENGTHENING PUBLIC HEALTH STRATEGY Address requests about publications of the WHO © World Health Organization 2017 All rights reserved.
    [Show full text]
  • Comment from Universal Health Coverage to Right Care for Health
    Comment THELANCET-D-16-08652 REQUESTED [PII_REPLACE] Embargo: January 8, 2017—23:30 (GMT) From universal health coverage to right care for health Achieving universal health coverage is the most happen side-by-side in different countries, within Published Online important means to advance health and wellbeing during countries, among populations, within institutions, January 8, 2017 http://dx.doi.org/10.1016/PII the next decade. Too many countries—and not only in and even for a single person. This situation offers an low-income or middle-income settings—do not have a enormous (and currently poorly recognised) opportunity See Online/Comment http://dx.doi.org/10.1016/ health system that provides “access to quality essential to tackle underuse and overuse together to achieve the S0140-6736(16)32570-3, and health-care services and access to safe, effective, quality right care for health and wellbeing. http://dx.doi.org/10.1016/ S0140-6736(16)32573-9 and affordable essential medicines and vaccines for all”, What is right care? In its simplest definition it is care See Online/Series 1 as described in Sustainable Development Goal 3.8. that weighs up benefits and harms, is patient-centred http://dx.doi.org/10.1016/PII, Even many high-income countries, such as the USA (taking individual circumstances, values, and wishes http://dx.doi.org/10.1016/ S0140-6736(16)32379-0, and the UK, see important inequalities in income, life into account), and is informed by evidence, including http://dx.doi.org/10.1016/ expectancy, and health outcomes,2,3 and the prevailing cost-effectiveness.
    [Show full text]
  • Quaternary Prevention: a Balanced Approach to Demedicalisation
    Life & Times Quaternary prevention: a balanced approach to demedicalisation In 1982, the Journal of the Royal College of General Practitioners published Ivan Illich’s “The main problem of overdiagnosis is overtreatment: article ‘Medicalization in Primary Care’.1 Illich held a paradoxical belief that GPs treating pseudo-diseases that bear no prospect of could contribute to the healthy process of benefit.” demedicalisation, that is: ‘... to offer their patients the occasion to patients end up dying from competing 10 years.7 This increases the overdiagnosis de-medicalize their own attitude to pain, diseases and not gaining in longevity. effect and offers minimal individual benefit. disability, discomfort, ageing, birth and The main problem of overdiagnosis is Regarding P2, there are lots of instances 1 death.’ overtreatment: treating pseudo-diseases of overmedicalisation due to non-evidence- that bear no prospect of benefit.6 This based screening for thyroid, prostate, and In other words, ‘unhooking [patients] represents harm both to individuals’ ovarian cancers. Breast cancer screening 1 from the health system’. This article wellbeing and to health systems as also needs to be readdressed. After an presents WONCA’s definition of Quaternary it generates unnecessary costs and average of two decades of breast cancer Prevention (P4) as a unifying framework that waste of resources. Potential sources screening in Canada8 and the US,9 there 2 organises GPs’ scope on demedicalisation. of overdiagnosis are disease screening, are considerable overdiagnosis rates altering cut-off points for defining a risk (roughly 30%), minimal (if any) impacts on EXPLAINING QUATERNARY PREVENTION factor or a disease, and financial incentives mortality,10 but known potential harms such Devised in 1986 by Marc Jamoulle, a (for example, pay-for-performance as an increase in heart disease (27%) and Belgian GP, P4 is: schemes).5 lung cancer (78%) mortality.11 Concerning P3, diabetes care provides a ‘..
    [Show full text]
  • Self-Assessment Tool for the Evaluation of Essential Public Health
    The WHO Regional Office for Europe SELF-ASSESSMENT TOOL FOR THE EVALUATION OF ESSENTIAL PUBLIC HEALTH OPERATIONS IN THE WHO EUROPEAN REGION The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Self-assessment tool for the Poland Portugal evaluation Republic of Moldova Romania Russian Federation of essential public health San Marino Serbia operations Slovakia Slovenia in the WHO European Region Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: [email protected] Website: www.euro.who.int Self-assessment tool for the evaluation of essential public health operations in the WHO European Region Abstract Through a process of extensive and iterative consultation, the WHO Regional Office for Europe devised 10 essential public health operations (EPHOs) that define the field of modern public health for the Member States in the WHO European Region. Formally endorsed by all of the Member States in the Region,the EPHOs form a comprehensive package that all Member States should aim to provide to their populations.The public health self-assessment tool presented here provides a series of criteria with which national public health officials can evaluate the delivery of the EPHOs in their particular settings.
    [Show full text]
  • National Cancer Institute University of Oxford
    SEPTEMBER 1-3, 2015 CO-SPONSORED BY NATIONAL CANCER INSTITUTE Division of Cancer Prevention UNIVERSITY OF OXFORD Centre for Evidence-Based Medicine NATCHER CONFERENCE CENTER National Institutes of Health | Bethesda, Maryland USA NOTICE OF PHOTOGRAPHY & FILMING Preventing Overdiagnosis 2015 is being visually documented. By your attendance you acknowledge that you have been informed that you may be photographed and recorded during this event . Images taken will be treated as property of Preventing Overdiagnosis and may be used in the future for promotional purposes. These images may be used without limitation by any organisation approved by the Preventing Overdiagnosis scientific committee and edited prior to publication as seen fit for purpose. Images will be available on the Internet, accessible to Internet users throughout the world including countries that may have less extensive data protection laws than partnering organisation countries. All films will be securely stored on the University of Oxford servers. Please make your- self known at the registration desk if you wish to remain off camera. Thank you for your cooperation. CONFERENCE PARTNERS The Dartmouth Institute Bond University, Centre for Research in Evidence-Based Practice The BMJ Consumer Reports University of Oxford, Centre for Evidence-Based Medicine The views expressed in these materials or by presenters or participants at the event do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, the National Institutes of Health, the National Cancer Institute, or any NIH component. TABLE OF CONTENTS WELCOME 2015 Scientific Committee 4 KEYNOTES BIOS 6 PROGRAMME 16 KEYNOTE ABSTRACTS 32 WORKSHOP ABSTRACTS 34 SEMINAR ABSTRACTS 48 PANEL SESSION ABSTRACTS 61 POSTERS 66 NOTES 67 MAPS WELCOME We are pleased to welcome you to the 3rd Preventing Overdiagnosis conference, held in Bethesda, Maryland on the campus of the US National Institutes of Health.
    [Show full text]
  • Putting Prevention Into Practice Guidelines for the Implementation of Prevention in the General Practice Setting
    Putting prevention into practice Guidelines for the implementation of prevention in the general practice setting Third edition Over 20 years of improving preventive health activities racgp.org.au Healthy Profession. Healthy Australia. Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting. Third edition Disclaimer The information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates. Accordingly, The Royal Australian College of General Practitioners Ltd (RACGP) and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Recommended citation The Royal Australian College of General Practitioners. Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting.
    [Show full text]
  • People Before Profits February 21 - 22, 2013
    Selling Sickness, 2013: People Before Profits February 21 - 22, 2013 bringing together ACADEMIC MEDICAL REFORMERS, CONSUMER ACTIVISTS, AND HEALTH JOURNALISTS to examine the current scope of disease mongering and to develop strategies and coalitions FOR CHANGE Hyatt Regency Washington on Capitol Hill Washington D.C. Floorplan REGENCY D REGENCY B REGENCY C GOOD NEWS EXHIBIT HALL Ballroom Level 2 Selling Sickness 2013: People Before Profits - Washington D.C. Table of Contents Conference Floorplan ............................................................................. 2 Welcome from Leonore and Kim ............................................................ 4 Special Thank Yous ............................................................................... 5 Disease-Mongering, defined.................................................................. 6 Call To Action On Disease Mongering ................................................... 7 Booktivism ............................................................................................. 9 Schedule-at-a-glance, Thursday, 2/21 ................................................... 10 Schedule-at-a-glance, Friday, 2/22 ........................................................ 11 Conference Program ............................................................................. 12 Wednesday, Registration, Social Hour .............................................. 12 Thursday morning sessions and break ............................................. 12 Thursday lunch .................................................................................
    [Show full text]