BMJ 的編輯支持“反對太多藥物的運動”，但敦促關注造成的傷害而不是財務成本。
by 理查德·西爾斯-2022 年 6 月 28 日

在一篇新的社論中，英國醫學雜誌的主編卡姆蘭·阿巴西 (Kamran Abbasi)討論了反對過度用藥的運動，重點是解決過度診斷和過度用藥問題。
In a new editorial, Kamran Abbasi, the editor in chief of The BMJ, discusses the campaign against too much medicine, which focuses on addressing overdiagnosis and overmedication.

Abbasi 解釋說，過度診斷和過度治療正在給我們的衛生系統造成重大負擔。我們不加批判地診斷的意願導致了醫療成本的增加、對員工、受傷患者的壓力以及進一步的環境惡化。目前的工作認為，我們需要關注該系統對患者造成的傷害，並優化數據以向患者和政策制定者展示這種傷害。
Abbasi explains that overdiagnosis and overtreatment are causing a significant burden on our health systems. Our willingness to uncritically diagnose has led to increased healthcare costs, pressure on staff, injured patients, and further environmental degradation. The current work argues that we need to focus on the harm this system causes to patients and optimize data to present that harm to patients and policymakers.

“關注過度診斷和過度治療對患者的危害將比關注成本更有力，”阿巴西寫道。“第二個變化領域是接受來自觀察和真實世界數據的證據，並優化數據以更好地告知臨床醫生和決策者關於危害的信息，同時不削弱精心設計的隨機對照試驗的重要性和中心性。”
“A focus on the harms to patients of overdiagnosis and overtreatment would make a more powerful argument than a focus on costs,” Abbasi writes. “A second area of change would be to embrace the evidence from observational and real-world data and to optimize data to better inform clinicians and policymakers about harms, without diluting the importance and centrality of well designed randomized controlled trials.”

許多研究人員指出了過度診斷和過度用藥的問題。研究發現，多動症可能在兒童和青少年中被過度診斷，使他們接觸到有害的興奮劑而幾乎沒有長期益處。同樣，專家警告說，青少年抑鬱症篩查會導致過度診斷，使兒童服用會顯著增加自殺風險的危險藥物，而缺乏實質性益處的證據。研究還發現，只有四分之一的兒科醫生在將這些標籤應用於兒童時會參考 DSM 診斷標準。
Many researchers have pointed to the problem of overdiagnosis and overmedication. Research has found that ADHD is likely overdiagnosed in children and teens, exposing them to harmful stimulants with little long-term benefit. Likewise, experts have warned that youth depression screening leads to overdiagnosis, subjecting children to dangerous drugs that significantly increase their risk of suicide with a lack of evidence for substantial benefits. Research has also found that only one in four pediatricians consult the DSM diagnostic criteria when applying these labels to children.

除兒童外，少數族裔可能面臨過度診斷和過度用藥的風險。例如，研究發現，由於臨床醫生對情緒障礙症狀的誤解，精神分裂症在非裔美國人中被過度診斷。另一項研究發現，性少數群體被過度診斷為邊緣型人格障礙。
In addition to children, minorities are likely at increased risk of overdiagnosis and overmedication. For example, research has found that schizophrenia is overdiagnosed in African Americans due to clinicians misinterpreting mood disorder symptoms. Another study has found that sexual minorities are overdiagnosed with borderline personality disorder.

過度診斷和過度用藥的問題不僅限於兒童和少數族裔，甚至不限於精神病學學科。研究已經解決了某些癌症初級保健中的過度診斷問題，發現僅乳腺癌過度診斷一項就可能使美國每年花費 40 億美元。這個問題在精神病學中非常明顯，以至於一位作者稱其為“診斷流行病”。”
The problem with overdiagnosis and overmedication is not limited to children and minorities or even to the discipline of psychiatry. Research has addressed overdiagnosis in primary care for certain cancers, finding that breast cancer overdiagnosis alone likely costs the United States $4 billion annually. This problem is so pronounced in psychiatry that one author has called it a “diagnostic epidemic.”

精神病學中的過度診斷會使服務使用者接觸到幾種危險且無效的藥物。例如，抑鬱症診斷後通常會開出抗抑鬱藥處方，這些藥物不會改善生活質量，但會帶來重大的健康風險，包括自殺。同樣，被診斷患有焦慮症的人通常會服用苯二氮卓類藥物，這種物質會導致身體依賴並導致長期傷害。此外，一些臨床醫生認為，長期使用抗精神病藥物可能不會顯著改善預後，並可能導致災難性的長期影響。
Overdiagnosis in psychiatry exposes service users to several dangerous and ineffective drugs. For example, a depression diagnosis is often followed by a prescription for antidepressants that do not improve quality of life but pose significant health risks, including suicide. Likewise, people diagnosed with anxiety disorders are commonly given benzodiazepines, a substance that can cause physical dependence and lead to long-term injury. Additionally, some clinicians have argued that the long-term use of antipsychotics may not significantly improve outcomes and can lead to disastrous long-term effects.

目前的工作首先解釋了對過度診斷的擔憂已經存在了一段時間。BMJ本身在 2002 年發布了一個主題問題，強調了過多藥物的危險。該主題的作者談到了將正常生活過程醫學化的風險。不幸的是，醫學學科並沒有適當地解決這個問題，正如目前推動使用不適合大多數女性的激素替代療法將更年期醫學化和藥物治療所證明的那樣。
The current work begins by explaining that concerns around overdiagnosis have existed for some time. BMJ itself released a theme issue in 2002 highlighting the dangers of too much medication. The authors in that theme issue spoke about the risks of medicalizing normal life processes. Unfortunately, this problem has not been appropriately addressed by the medical disciplines, as evidenced by the current push to medicalize and medicate menopause with hormone replacement therapies that are not appropriate for most women.

雖然許多研究人員和服務用戶擔心過度診斷和過度用藥，但“工業化醫學”幾乎沒有減弱。工業用它的錢向毫無戒心的公眾“推銷疾病”，依靠恐懼和壓倒性的情緒來說服人們服用危險和不必要的藥物，讓醫療專業人員、服務使用者和地球付出巨大代價。政治家和衛生專業人員也經常被誤導，加劇了過度診斷的問題。此外，作者指出，一些人群經常被診斷不足和治療不足，使這些討論進一步複雜化。
While many researchers and service users are concerned about overdiagnosis and overmedication, “industrialized medicine” continues nearly unabated. Industry uses its money to “sell sickness” to the unsuspecting public, relying on fear and overwhelming emotions to convince people to take dangerous and unnecessary drugs at great cost to medical professionals, service users, and the planet. Politicians and health professionals are often misled as well, compounding the problems of overdiagnosis. In addition, the author states that some populations are routinely underdiagnosed and undertreated, further complicating these discussions.

儘管所有這些問題可能使反對過多藥物的努力似乎幾乎失敗了，但阿巴西認為，由於壓倒性的證據、系統內的人們真誠地工作以及不斷下降的影響力，它最終會成功。隨著社會變得更加開放，行業資金。
While all these problems may make it seem as if the push against too much medicine has all but lost the fight, Abbasi believes it will ultimately succeed due to the overwhelming evidence, the people within the system working in good faith, and the declining influence of industry money as societies become more open.

為了反對過多的藥物做出有意義的改變，作者認為該運動需要關注兩個領域。首先，他們需要強調“低價值的醫療保健”會傷害人們。與其當前關注“低價值醫療保健”的財務成本，不如關注人力成本。其次，該運動必須在不損害隨機對照試驗標準的情況下接受觀察性和真實世界的證據，並以可口的方式向服務用戶和決策者提供這些證據。阿巴西總結道：
For the push against too much medicine to make meaningful change, the author believes the campaign needs to focus on two areas. First, they need to emphasize that “low-value healthcare” hurts people. Rather than the current focus on the financial costs of “low-value healthcare,” they should be focusing on the human cost. Second, the campaign must embrace observational and real-world evidence without compromising the standard of randomized control trials and present this evidence in palatable ways to service users and policymakers. Abbasi concludes:

“最重要的是，反對過多藥物的運動需要重新設置系統，以從言辭和零散的證據轉變為可操作的證據和可衡量的影響。”
“Above all, the campaign against too much medicine needs a system reset to move from rhetoric and scattered evidence to actionable evidence and measurable impact.”****

Abbasi, K. (2022)。為反對過多藥物的運動而重置系統。英國醫學雜誌， o1466。https://doi.org/10.1136/bmj.o1466 （鏈接）
Abbasi, K. (2022). A system reset for the campaign against too much medicine. BMJ, o1466. https://doi.org/10.1136/bmj.o1466 (Link)

文章來源:
https://www.madinamerica.com/2022/06/doctors-renew-campaign-overdiagnosis-overmedication/

理查德·西爾斯理查德·西爾斯（Richard Sears）在西喬治亞技術學院教授心理學，並正在攻讀西喬治亞大學的意識與社會博士學位。他之前曾在危機穩定部門工作，擔任進氣評估員和危機熱線操作員。他目前的研究興趣包括機構和組成機構的個人之間的劃分、去人性化及其與興奮的關係，以及潛在有害的心理藥理學乾預的天然替代品。

Richard SearsRichard Sears teaches psychology at West Georgia Technical College and is studying to receive a PhD in consciousness and society from the University of West Georgia. He has previously worked in crisis stabilization units as an intake assessor and crisis line operator. His current research interests include the delineation between institutions and the individuals that make them up, dehumanization and its relationship to exaltation, and natural substitutes for potentially harmful psychopharmacological interventions.