How to rein in the widening disease definitions

 

In the early 1990s a small meeting of experts, part-funded by drug companies, decided on a new definition of the bone condition osteoporosis. Historically, the label was limited to people who had fractures, but with the coming of new technology that could see someone’s bone density, doctors started broadening the definition to include healthy people considered at risk of a fracture.

The experts arbitrarily and controversially created a new cut-off for diagnosis that classified more than a quarter of all post-menopausal women as having the “disease”. The following year (1995) pharmaceutical company Merck launched Fosamax, a drug for osteoporosis that would soon become a multi-billion-dollar blockbuster.

In 2008 a guideline from the United States National Osteoporosis Foundation further increased the numbers, with a recommendation that more than 70% of white women over 65 should take osteoporosis drugs. With medication, of course people benefit by avoiding a fracture. But many of those at low risk will suffer more harm than good, unnecessarily taking potentially harmful drugs.

Osteoporosis is just one condition that has had its definitions widen over time and, with that, the pool of people diagnosed as having it. An article published today in the journal JAMA Internal Medicine outlines the first serious attempt to set some global rules for those experts who move diagnostic goalposts that label more people as sick.