Digest News


“Disease mongering” burdens global healthcare


EXPANDING definitions of disease are leading to overdiagnosis and unnecessary treatment, and pose a threat to human health and the sustainability of health systems, according to a paper published in BMJ Evidence-Based Medicine. The authors cite evidence suggesting that specialist guideline groups which regularly review disease definitions often decide to expand them by lowering thresholds to capture more people at lower risk of future illness and by creating pre-diseases. There can also be a tendency to over-medicalise common or mild life experiences, or to change diagnostic processes.


The authors contend this is leading to


overdiagnosis and overtreatment, and that the specialist panels proposing these expansions are often conflicted and do not investigate potential harms. Examples cited include the widely used definition of chronic kidney disease, which the researchers claim could apply to around half of all older people although many will never experience related symptoms, and a “new definition of hypertension which labels one in every two adults”. The paper is calling for new ways to define disease in order to reduce overdiagnosis. Such processes would involve using “explicit guidance to assess potential benefits and harms when modifying disease definitions, with a focus on people-centred outcomes”. Decision panels should also be “primary-care led, multidisciplinary, with representation from civil society and independent from financial ties to industry”. Access the paper at tinyurl.com/y3fjtdga


Record numbers get NHS cancer checks


THE number of people checked for signs of cancer exceeded two million for the first time last year, NHS England has revealed. In 2018, a record 2.2 million checks were carried out in England following urgent referrals by GPs – an increase of almost 250,000 compared to 2017. The number of people receiving treatment for cancer also topped 300,000 for the first time last year, a rise of almost 13,000 on the year before. New figures show cancer survival is at an all-time high, with 10,000 more patients surviving for at least 12 months after diagnosis, compared to five years earlier. But the NHS Long Term Plan aims to go even further and increase the proportion of cancers caught early from half to three-quarters, a move that would save as many as 55,000 more


6 / MDDUS INSIGHT / Q2 2019 Burnout or “moral injury”


A NEW BMA survey has found that eight out of 10 doctors are at substantial risk of burnout. The survey of 4,300 doctors also found that more than a quarter had received previous, formal diagnoses of mental conditions, and four out of 10 said they were suffering from psychological or emotional distress which affected their work, training or study. Younger and junior doctors, medical students and those working longer hours are more likely to suffer from mental ill health. Over 60 per cent of respondents with current or previous mental health diagnoses used alcohol, drugs and self-medications as a coping mechanism. Men and older doctors were most likely to engage in such behaviour. Recently in a keynote speech to the Royal College of Physicians (RCP) annual conference,


RCP president Professor Andrew Goddard questioned use of the term ‘burnout’. He commented: “What we call burnout, that sense of despair, hopelessness and loss of joy is not due to a failure of the individual. It is a failure of the environment they work in, the culture of the workplace, the workload imposed on this. Some, particularly in the States, have started to call this process ‘moral injury’ as it puts the onus back on the system.” Professor Goddard says he is awaiting the new Workforce Implementation Plan from NHS England and NHS Improvement, but underlines how important it is for doctors to support each other.


lives each year. NHS England’s national director for


cancer, Cally Palmer, said: “Thanks to a greater awareness of symptoms, more people than ever before are coming forward to get checked for cancer.”


Only three per cent of under-ones attend dentist


RESEARCH from Birmingham University has found that only three per cent of under-ones in England attended the dentist and in some regions it was less than one per cent. The British Dental Association (BDA) has said the figures are indicative of a failure of successive governments to offer a joined-up approach to the oral health of children in England. BDA Chair Mick Armstrong said: “Baby teeth matter, and getting very young kids


attending requires joined-up action. Sadly ministers have offered little more than posters to pop up in dental practices. “Preaching to the converted will not cut


it. We need real engagement in schools and nurseries, and Scotland and Wales are already leading the way. Kids in England deserve better than a second-class service.”


Involve dentists in wider disease prevention


DENTISTS could play a much wider role in detecting health conditions such as diabetes and cardiovascular disease, says the Faculty of Dental Surgery.


The FDS has published a Position Statement


on oral health and general health suggesting that dentistry could be better utilised in the diagnosis of certain wider health problems and also in providing preventative health


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