期刊
JOURNAL OF EVALUATION IN CLINICAL PRACTICE
卷 24, 期 5, 页码 1019-1025出版社
WILEY
DOI: 10.1111/jep.12909
关键词
diagnosis; philosophy of medicine
资金
- Australian Research Council Future Fellowship [FT130100346]
- Macquarie University Future Fellowship start-up fund
- Australian Research Council Centre of Excellence [ID CE140100012]
- Australian Research Council [FT130100346] Funding Source: Australian Research Council
Roughly, overdiagnosis (ODx) occurs when people are harmed by receiving diagnoses (often accompanied by interventions) that do not benefit them, usually because the diagnosed conditions do not pose a threat to their health. ODx is a theoretical as well as a practical problem as it relates to definitions of disease. Elsewhere, it has been argued that disease is a vague concept and that this vagueness may contribute to ODx. In response, we develop a stipulative or precising definition of disease, for the specific purpose of decreasing or preventing ODx. We call this disease(ODx), aimed at distinguishing cases where it would be beneficial to identify (and treat the condition) from those where diagnosis is more likely to harm than benefit. A preliminary definition of disease(ODx) is that X is a disease(ODx) iff there is dysfunction that has a significant risk of causing severe harm. This paper examines the 3 concepts in this definition, using a naturalistic account of function, a Feinbergian account of comparative harm, and a probabilistic understanding of risk. We then test the utility of this approach using examples of clinical conditions that are currently overdiagnosed.
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