Diagnosis targets in primary care are misleading, unethical, UK experts say

Last month, there was public outcry at the news that GPs in England would be paid £55 for each case of dementia diagnosed.

Now come targets for six other conditions, including diabetes coronary heart disease, asthma and depression, writes Dr Martin Brunet, a GP in Surrey. "But the data on which they are based are flawed, and the approach incentivises potentially harmful overdiagnosis," he argues.

Every practice in England has been told its diagnosis rate for each condition, estimated from practice data and the expected prevalence, he explains. The intention is to exert pressure on general practitioners to increase diagnosis rates, but he believes the principles behind such a policy need to be questioned.

Brunet argues that applying error prone national prevalence data to an individual practice is problematic. Although attempts are made to account for local demographics, practices may be under pressure to "improve" diagnosis rates that are far better than the data would suggest, he warns.

He also questions the ethical implications for individual patients of unnecessary tests and treatments that "could do more harm than good" and divert resources away from people with symptoms.

Targets in healthcare always threaten to undermine trust in the doctor-patient relationship, says Brunet. "For this reason patients need to trust that the doctor will act solely in their best interests, unencumbered by competing interests."

"NHS England needs to hear the clear message from doctors and patients that setting targets for diagnosis is problematic, unscientific, and unethical," he argues. "Instead, it needs to trust doctors and their patients to know when to seek a diagnosis."

Source: BMJ-British Medical Journal

How to sell the drugs of the future

Drugs
Credit: Getty Images

Only a decade ago, basing medical treatment on your DNA seemed like science fiction. Not any more. Thanks in part to the sequencing of the human genome, personalized medicine (PM), a specific course of treatment developed for the individual patient, is now science fact.

PM has already shown its effectiveness in the treatment of cancer, and medical professionals are eager to expand it to treat other chronic diseases. But first patients need to understand how PM can work for them.

Will they buy into it? "Yes -- but only if patients are armed with knowledge about their own disease and understand the relative advantages of PM," says Concordia University marketing professor Lea Prevel Katsanis, the co-author of a new study on the subject, published in the International Journal of Pharmaceutical and Healthcare Marketing. She adds that if patients are going to accept PM, doctor-patient communication is vital.

For the study, Katsanis and her co-author, Anja Hitz, a former John Molson School of Business MBA student and current head of medical compliance and prevention at the Military Hospital in Hamburg, Germany, polled 307 consumers through an online survey. 
They found that knowledge and the relative advantages of PM have the most significant influence on patient acceptance of PM.

"The more a patient knows about how she is being treated, the more likely she is to accept that treatment," says Katsanis. "So it's important to educate consumers on potential benefits and risks associated with PM."

Indeed, patient understanding is a key factor in getting healthcare professionals, governments and insurance companies to adopt and pay for PM, particularly when these targeted treatments are often more costly than traditional medical methods.

With PM, the same drug isn't given to millions of people. It's a targeted treatment regime. While that reduced patient pool means an increased cost, there can be long-term benefits. Increased efficiency and prevention may result in fewer drugs being prescribed. And PM may also result in the reduction of secondary costs as a result of overdosing, incorrect prescriptions and adverse drug reactions.

"If PM can be successfully integrated into the healthcare system at a reasonable cost, it represent a significant improvement in the treatment of chronic disease," says Katsanis.

But she warns that marketers need to proceed with caution: "The promotion of personalized medications will increasingly focus on the healthy patient with a genetic disposition for a particular illness. While this might lead to new and potentially greater opportunities for marketers, it might also result in the targeting of healthy patients who don't actually need treatment for an active disease. Ultimately, this could increase healthcare costs and cause unnecessary patient treatment."

Source: Concordia University