Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Overdiagnosis. Show all posts
Showing posts with label Overdiagnosis. Show all posts

Wednesday, December 27, 2023

This algorithm could predict your health, income, and chance of premature death

Holly Barker
Science.org
Originally published 18 DEC 23

Here is an excerpt:

The researchers trained the model, called “life2vec,” on every individual’s life story between 2008 to 2016, and the model sought patterns in these stories. Next, they used the algorithm to predict whether someone on the Danish national registers had died by 2020.

The model’s predictions were accurate 78% of the time. It identified several factors that favored a greater risk of premature death, including having a low income, having a mental health diagnosis, and being male. The model’s misses were typically caused by accidents or heart attacks, which are difficult to predict.

Although the results are intriguing—if a bit grim—some scientists caution that the patterns might not hold true for non-Danish populations. “It would be fascinating to see the model adapted using cohort data from other countries, potentially unveiling universal patterns, or highlighting unique cultural nuances,” says Youyou Wu, a psychologist at University College London.

Biases in the data could also confound its predictions, she adds. (The overdiagnosis of schizophrenia among Black people could cause algorithms to mistakenly label them at a higher risk of premature death, for example.) That could have ramifications for things such as insurance premiums or hiring decisions, Wu adds.


Here is my summary:

A new algorithm, trained on a mountain of Danish life stories, can peer into your future with unsettling precision. It can predict your health, income, and even your odds of an early demise. This, achieved by analyzing the sequence of life events, like getting a job or falling ill, raises both possibilities and ethical concerns.

On one hand, imagine the potential for good: nudges towards healthier habits or financial foresight, tailored to your personal narrative. On the other, anxieties around bias and discrimination loom. We must ensure this powerful tool is used wisely, for the benefit of all, lest it exacerbate existing inequalities or create new ones. The algorithm’s gaze into the future, while remarkable, is just that – a glimpse, not a script. 

Monday, December 11, 2023

Many Americans receive too much health care. That may finally be changing

Elsa Pearson Sites
StatNews.com
Originally published 8 Nov 23

The opioid crisis rocked America, bringing addiction and overdose into the spotlight. But it also highlighted the overtreatment of pain: Medical and dental providers alike overprescribed opioids after procedures and for chronic conditions. Out of that overtreatment came an epidemic.

In American health care, overtreatment is common. Recently though, there has been a subtle shift in the opposite direction. It’s possible that “less is more” is catching on.

For many Americans, it can be challenging to even access care: Treatment is expensive, insurance is confusing, and there aren’t enough providers. But ironically, we often use too much care, too.

Now, some providers are asking what the line between necessary and unnecessary really is. The results are encouraging, suggesting that, in some cases, it may be possible to achieve the same health outcomes with less treatment — and fewer side effects, too.

This shift is particularly noticeable in cancer care.


Here is my take:

The article delves into the pervasive issue of overtreatment and overdiagnosis in the healthcare system. It highlights the unintended consequences of modern medical practices, where patients are often subjected to unnecessary tests, procedures, and treatments that may not necessarily improve their health outcomes. The article emphasizes how overtreatment can lead to adverse effects, both physically and financially, for patients, while overdiagnosis can result in the unnecessary burden of managing conditions that may never cause harm. The piece discusses the challenges in striking a balance between providing thorough medical care and avoiding unnecessary interventions, urging a shift toward a more patient-centered and evidence-based approach to reduce harm and improve the overall quality of healthcare.

The author suggests that addressing the issue of overtreatment and overdiagnosis requires a comprehensive reevaluation of medical practices, incorporating shared decision-making between healthcare providers and patients. The article underscores the importance of fostering a healthcare culture that prioritizes the avoidance of unnecessary interventions and aligns treatments with patients' preferences and values. By acknowledging and addressing the challenges associated with overmedicalization, the article advocates for a more thoughtful and personalized approach to healthcare delivery that considers the potential harm of unnecessary treatments and strives to enhance the overall well-being of patients.

Saturday, February 18, 2017

Is It Time to Call Trump Mentally Ill?

Richard A. Friedman
The New York Times
Originally published February 17, 2017

Here are two excerpts:

A recent letter to the editor in this newspaper, signed by 35 psychiatrists, psychologists and social workers, put it this way: "We fear that too much is at stake to be silent." It continued, "We believe that the grave emotional instability indicated by Mr. Trump's speech and actions makes him incapable of serving safely as president."

But the attempt to diagnose a condition in President Trump and declare him mentally unfit to serve is misguided for several reasons.

First, all experts have political beliefs that probably distort their psychiatric judgment. Consider what my mostly liberal profession said of Senator Barry Goldwater, the Republican nominee for president in 1964, right before the election. Members of the American Psychiatric Association were surveyed about their assessment of Goldwater by the now-defunct Fact magazine. Many savaged him, calling him "paranoid," "grossly psychotic" and a "megalomaniac." Some provided diagnoses, like schizophrenia and narcissistic personality disorder.

They used their professional knowledge as a political weapon against a man they had never examined and who certainly would never have consented to their discussing his mental health in public.

Goldwater sued (successfully) and, as a result, in 1973 the A.P.A. developed the Goldwater Rule. It says that psychiatrists can discuss mental health issues with the news media, but that it is unethical for them to diagnose mental illnesses in people they have not examined and whose consent they have not received.

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There is one last reason we should avoid psychiatrically labeling our leaders: It lets them off the moral hook. Not all misbehavior reflects psychopathology; the fact is that ordinary human meanness and incompetence are far more common than mental illness. We should not be in the business of medicalizing bad actors.

The article is here.

Thursday, December 26, 2013

Debating DSM-5: diagnosis and the sociology of critique

By Martyn Pickersgill
Journal of Medical Ethics
J Med Ethics doi:10.1136/medethics-2013-101762

Abstract

The development of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance.

The entire article is here.

Thursday, November 7, 2013

The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic

By MAGGIE KOERTH-BAKER
The New York Times
Published: October 15, 2013

Here are two excerpts:

Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Which is not to say that A.D.H.D. is a made-up disorder.

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This lack of rigor leaves room for plenty of diagnoses that are based on something other than biology. Case in point: The beginning of A.D.H.D. as an “epidemic” corresponds with a couple of important policy changes that incentivized diagnosis. The incorporation of A.D.H.D. under the Individuals With Disabilities Education Act in 1991 — and a subsequent overhaul of the Food and Drug Administration in 1997 that allowed drug companies to more easily market directly to the public — were hugely influential, according to Adam Rafalovich, a sociologist at Pacific University in Oregon.

The entire article is here.

Wednesday, August 28, 2013

A Glut of Antidepressants

By RONI CARYN RABIN
The New York Times
Originally published August 12, 2013

Over the past two decades, the use of antidepressants has skyrocketed. One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.

Experts have offered numerous reasons. Depression is common, and economic struggles have added to our stress and anxiety. Television ads promote antidepressants, and insurance plans usually cover them, even while limiting talk therapy. But a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale.

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Elderly patients were most likely to be misdiagnosed, the latest study found. Six out of seven patients age 65 and older who had been given a diagnosis of depression did not fit the criteria. More educated patients and those in poor health were less likely to receive an inaccurate diagnosis.

The entire article is here.

Wednesday, May 22, 2013

Medicine's big new battleground: does mental illness really exist?

The latest edition of DSM, the influential American dictionary of psychiatry, says that shyness in children, depression after bereavement, even internet addiction can be classified as mental disorders. It has provoked a professional backlash, with some questioning the alleged role of vested interests in diagnosis

By Jaime Doward
The Observer
Originally published May 11, 2013

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry's dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association's increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry's critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: "Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?"

Psychiatry's supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

The entire article is here.

Tuesday, May 21, 2013

DSM-IV Boss Presses Attack on New Revision

By John Gever, Deputy Managing Editor
MedPage Today
Published: May 17, 2013

A new edition of psychiatry's diagnostic guide "will probably lead to substantial false-positive rates and unnecessary treatment," charged the man who led development of the last version.

To be released this weekend at the American Psychiatric Association's annual meeting, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, "introduce[s] several high-prevalence diagnoses at the fuzzy boundary with normality," according to Allen Frances, MD, who chaired the task force responsible for DSM-IV issued in 1994.

Frances, now an emeritus professor at Duke University, wrote online in Annals of Internal Medicine that changes from DSM-IV will apply disease labels to individuals who may be unhappy or offensive but still normal. Such individuals would include those experiencing "the forgetfulness of old age" as well as children with severe, chronic temper tantrums and individuals with physical symptoms with no medical explanation.

He also worried about new marketing pushes from the pharmaceutical industry seeking to exploit what he believes are "loose" diagnostic criteria in the new edition. "Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form," he wrote.

The entire article is here.

Saturday, May 18, 2013

New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

By Greg Miller
Wired Science
Originally posted May 17, 2013

Thousands of psychiatrists will descend on San Francisco this weekend for a meeting that will mark the release of the latest edition of the profession’s diagnostic guide, the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This hugely influential book has been 14 years in the making, and it’s been dogged by controversies every step of the way.

To name just a few, there have been allegations of financial conflicts of interest, debates over whether internet addiction is really a thing (it is not, but “disordered gambling” is), arguments that the new diagnostic criteria will medicalize normal grief and temper tantrums, and lead to millions of people being falsely diagnosed with mental disorders.

With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.


The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

The entire story is here.

Saturday, April 6, 2013

A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise

By ALAN SCHWARZ and SARAH COHEN
The New York Times
Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The entire story is here.

Friday, November 9, 2012

DSM-5 Field Trials Discredit the American Psychiatric Association

By Allen Frances, M.D.
The Huffington Post
Originally posted October 31, 2012

The $3 million DSM-5 Field Trials have been a pure disaster from start to finish. First, there was the poor choice of design. The study restricted itself to reliability -- the measurement of diagnostic agreement among different raters. Unaccountably, it failed to address two much more crucial questions -- DSM-5's potential impact on who would be diagnosed and on how much its dramatic lowering of diagnostic thresholds would increase the rates of mental disorder in the general population. There was no possible excuse for not asking these simple-to-answer and vitally important questions. We have a right to know how much DSM-5 will contribute to the already rampant diagnostic inflation in psychiatry, especially since this risks even greater overuse of psychotropic drugs.

The entire story is here.

Monday, April 9, 2012

Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis.

By Katrin Bruchmuller, Jurgen Margraf, and Silvia Schneider
Journal of Consulting and Clinical Psychology, Vol 80(1), Feb 2012, 128-138.
 
Abstract
 
Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male–female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6–9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) and International Classification of Diseases (10th rev.; ICD–10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would.
 
Method: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM–IV/ICD–10 criteria of ADHD. Vignettes 2–4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created.
 
Results: In Vignettes 2–4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes.
 
Conclusions: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.