Ray Moynihan

Preventing overdiagnosis: How to stop harming the healthy

Evidence is mounting that medicine is harming healthy people through ever earlier detection and ever wider definition of disease. With the announcement of an international conference to improve understanding of the problem of overdiagnosis, Ray Moynihan, Jenny Doust, and David Henry examine its causes and explore solutions

Coverage by the News Media of the Benefits and Risks of Medications

BACKGROUND The news media are an important source of information about new medical treatments, but there is concern that some coverage may be inaccurate and overly enthusiastic. METHODS We studied coverage by U.S. news media of the benefits and risks of three medications that are used to prevent major diseases. The medications were pravastatin, a cholesterol-lowering drug for the prevention of cardiovascular disease; alendronate, a bisphosphonate for the treatment and prevention of osteoporosis; and aspirin, which is used for the prevention of cardiovascular disease. We analyzed a systematic probability sample of 180 newspaper articles (60 for each drug) and 27 television reports that appeared between 1994 and 1998. RESULTS Of the 207 stories, 83 (40 percent) did not report benefits quantitatively. Of the 124 that did, 103 (83 percent) reported relative benefits only, 3 (2 percent) absolute benefits only, and 18 (15 percent) both absolute and relative benefits. Of the 207 stories, 98 (47 percent) mentioned potential harm to patients, and only 63 (30 percent) mentioned costs. Of the 170 stories citing an expert or a scientific study, 85 (50 percent) cited at least one expert or study with a financial tie to a manufacturer of the drug that had been disclosed in the scientific literature. These ties were disclosed in only 33 (39 percent) of the 85 stories. CONCLUSIONS News-media stories about medications may include inadequate or incomplete information about the benefits, risks, and costs of the drugs as well as the financial ties between study groups or experts and pharmaceutical manufacturers.

Who pays for the pizza? Redefining the relationships between doctors and drug companies. 2: Disentanglement

In this two part article, a journalist based in Washington DC explores the brewing conflicts at one of the worlds leading medical campuses as it joins the wider global debate about how to redefine relations with big pharmaceutical companies

Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased

#### Summary box In 2002 the United States Kidney Foundation launched a novel framework for defining and classifying chronic kidney disease.1 The framework was widely embraced because it imposed order in a chaotic landscape characterised by a variety of names, including renal insufficiency, renal impairment, and renal failure. It has had an appreciable effect on clinical care worldwide through guidelines,2 pay for performance measures, …

Too much medicine; too little care

Time to wind back the harms of overdiagnosis and overtreatment

Drugs for pre-osteoporosis: prevention or disease mongering?

After looking at data used to support treatment of women with slightly lowered bone mineral density, Pablo Alonso-Coello and colleagues argue thatproponents have overstated the benefits and underplayed the harms

Disease Mongering Is Now Part of the Global Health Debate

Ray Moynihan and colleagues, who organized the worlds first international conference on disease mongering in 2006, discuss its subsequent impact.

Doctors’ education: the invisible influence of drug company sponsorship

As calls to end drug companies’ direct sponsorship of doctors’ education echo round the world, an investigation in Australia reveals sponsor involvement in the education of thousands of general practitioners, writes Ray Moynihan

Walking the tightrope: communicating overdiagnosis in modern healthcare

Communication that empowers the public, patients, clinicians, and policy makers to think differently about overdiagnosis will help support a more sustainable healthcare future for all, argue Kirsten McCaffery and colleagues

Winding back the harms of too much medicine

Registration is opening and abstracts closing soon for our “Preventing Overdiagnosis” conference