The historical rise of “overdiagnosis”—an essay by Scott Podolsky

In April 1924 a Winnipeg physician, James Douglas Adamson, gave an address on Over-Diagnosis of Pulmonary Tuberculosis at a conference of medical superintendents in Ottawa.1 “Phthisis is a disease which when incipient is hard to diagnose and easy to cure but when far advanced is easy to diagnose and hard to cure,” he began, hearkening back to Hippocrates. In the 20th century, noted Adamson, advances in treatment such as the sanatorium “have all in turn increased the demand for early diagnosis until now it is recognized as a sine qua non of adequate treatment.” And yet, such demand had “an undesirable by-product which must be recognized and guarded against.”That by-product was overdiagnosis. Adamson said that it was “bad for the patient physically, financially, and psychically; bad for the physician mentally and morally; bad for the country economically.”Many of the themes that would characterise late 20th and early 21st century concerns…
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