Hofmann Bjørn
Institute for the Health Sciences, The Norwegian University Science and Technology, PO Box 1, 2802, Gjøvik, Norway.
Centre for Medical Ethics, The University of Oslo, Oslo, Norway.
Med Health Care Philos. 2017 Dec;20(4):453-464. doi: 10.1007/s11019-017-9776-z.
Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it "cancer screening" when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis.
过度诊断与疾病是相关概念。对疾病概念的拓宽会增加过度诊断，反之亦然。部分原因在于疾病与过度诊断之间存在紧密且复杂的关系。为解决过度诊断的问题，更深入地理解这种关系或许会对我们有所助益。因此，本文的目的是阐明疾病与过度诊断之间的关系。为此，本文首先审视过度诊断如何解释疾病概念的扩展。接着探究疾病的定义如何应对过度诊断的各种挑战。本文特别考察了近期阐明疾病概念与过度诊断之间关系的尝试。识别出了若干不足之处，并促使对诊断过程中的过度诊断进行更深入的分析。与该领域近期的观点相反，本文认为过度诊断的病例并非疾病病例。它们是对疾病的未经证实的标记。揭示了过度诊断如何在诸如息肉或细胞变化等指示性现象与伤害之间建立起无根据的联系，从而与疾病产生关联。这项研究的一个启示是，我们应停止将疾病相关的表述用于指示性现象。也就是说，当我们实际上是在寻找息肉时，不应再称之为“癌症筛查”。另一个启示是，我们应努力在区分对我们有负面价值的现象与无负面价值的现象方面取得科学进展。在过度诊断中，我们诊断的是并非疾病的东西：这就是过度诊断。
