What is too much medicine and why is it a problem?
Everyone’s heard how medicalization is a growing threat for our wellbeing in modern society, but what many medical professionals actually worry about is a larger challenge called “too much medicine”. To find out what this means, we interviewed Kari Tikkinen, adjunct professor of clinical epidemiology and urology resident at University of Helsinki and secretary general of the Too Much Medicine Symposium.
Kari Tikkinen first became interested in the themes of too much medicine when he researched overactive bladder in his doctoral thesis. Overactive bladder is not a disease, instead it’s a name of a group of urinary symptoms.
“I saw how big a commercial interest there was regarding this overactive bladder. There were lots of so called ‘satellite symposia’ in fine arenas organised by the industry. The message was that overactive bladder is unrecognized, under-diagnosed and undertreated.”
But according to research conducted by Mr. Tikkinen and his team, in reality these symptoms were much rarer than the messages in the industry implied.
“I observed that this is a common phenomenon when a new medication is entering to the market. Industry-sponsored studies first exaggerate the prevalence estimates with an aim to create a market for the product, stating that disease is truly very common, and that doctors don’t recognise it and it’s treated insufficiently. Overactive bladder symptoms are unpleasant and my interest in clinical work, and they should not to be downplayed. However, the creation of new disease and strong marketing by industry led to an overuse of these drugs.”
Tikkinen states that as he became he more acquainted with the phenomenon, the better he noticed that in every field of medicine there is some sickness, risk factor or symptom that can be treated with medication and in which the industry has an interest in selling more medications. The way to sell is to modify the definitions of the diseases and create a feeling that they are common and undertreated. To increase the profits the indications are made wider, for example same medication can be sold first to moderate or severe depression, then to milder and milder forms of the condition. Treatment of mild forms is very profitable as mild symptoms are very common.
And why are overdiagnosis and overtreatment problematic? According to Tikkinen, they are not only a problem for those who undergo unnecessary diagnostic tests and treatments, but also for those who really need treatment but are forced to queue. Searching the balance between overdiagnosis and underdiagnosis seems to be an eternal challenge, but during the last 5-10 years overdiagnosis has arisen to be discussed in public.
How does this discussion of overdiagnosis differ from medicalisation? Tikkinen says that they are different but overlapping concepts. Overdiagnosis is about diagnosing a disease that wouldn’t cause any harm or shorten the lifespan, and medicalisation is about medicine spreading to fields that haven’t been formerly considered medical.
The drivers of the too much medicine phenomenon are the fear of underdiagnosis, the false idea that prevention is always better, the idea that treating more and early is always better, as well as the technological improvements and widened definitions of diseases.
”Too much medicine is not a problem in just one field of medicine. It effects for example diagnosing osteoporosis, cholesterol level guidelines, ADHD medications, levels of or treating low-risk prostate and thyroid cancers, just to name few” Tikkinen states.
Too Much Medicine Challenge
In honour of the Too Much Medicine International Medical Symposium 2018 in Helsinki, Helsinki Think Company and Too Much Medicine Symposium are bringing together students to ideate how to make people understand that more medicine is not always better for them.
We are calling for motivated, open-minded students ready to challenge themselves and the current mindset during a weekend of multidisciplinary coworking.
All teams taking part in the Too Much Medicine Challenge will receive free access to the Too Much Medicine Symposium as volunteers. This is a unique role you can’t apply for otherwise and it’s also fascinating opportunity to learn more from international top speakers and scientists, meet inspiring people and build your network.
Apply by 8.4: thinkcompany.fi/toomuch