There are several factors which increase our propensity to overdiagnose, whereas the root cause of overdiagnosis is imperfect information and the trade-offs as a result of that imperfection.
Overdiagnosis is the finding of mild disease for which the harms in diagnosing and treating exceed the benefits . Overdiagnosis is a problem of modernism and affluence. It is not a significant issue in developing countries, where people still die from infectious diseases. Overdiagnosis, however, affects even the poorer citizens in developed countries because health care has little granularity or ability to discern shades of importance.
Many etiologies are offered for overdiagnosis including a payment structure which rewards expansion of disease definition, influence of pharmaceutical companies and disease advocacy groups, and defensive medicine. However, these factors, though contributory, do not explain the root of overdiagnosis. Broadly, overdiagnosis occurs because of a convergence of two factors, imperfect information (the information problem), and the push for anticipatory medicine. Overdiagnosis is fundamentally an epistemologic problem.
Imperfect information
We do not have perfect information in medicine. If we did, we could use the right test in the right patient to reach the right diagnosis so that we could administer the right treatment in the right amount leading to neither underdiagnosis and undertreatment nor overdiagnosis and overtreatment. Imperfect information creates an information problem. An example of an information problem is knowing in which patients with papillary carcinoma of the thyroid, the tumor will progress to metastatic cancer and curtail life expectancy.
The triad of the information problem is as follows.
1) Many patients will not be harmed (A).
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References
1. Black W.C., Welch H.G.: Advances in diagnostic imaging and estimations of disease prevalence and benefits of therapy. NEJM 1993; 328: pp. 1237-1243.
2. Harach H.R., Fransilla K.O., Wasenius V.M.: Occult papillary carcinoma of the thyroid: a “normal” finding in Finland: a systematic autopsy study. Cancer 1985; 56: pp. 531-558.