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February 7, 2020

Potential Consequences of Changing Disease Classifications

Author Affiliations
  • 1Centre for Longitudinal and Life Course Research, The University of Queensland School of Public Health, Herston, Queensland, Australia
  • 2Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
  • 3Sydney School of Public Health, Sydney Medical School Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
JAMA. 2020;323(10):921-922. doi:10.1001/jama.2019.22373

Clinicians tend to think of diseases as being immutable, existing in nature like elements of the periodic table or the planets. The medical literature reinforces this myth, implying that changes are a result of increasing scientific knowledge moving medicine toward better and more accurate descriptions of these natural kind concepts. In fact, diseases are not fixed, and even with common diseases (such as diabetes, depression, and anemia), their definitions have changed considerably over time, with significant, but often unrecognized harmful, potential consequences for patients. What constitutes a disease may change in 1 of 3 ways: (1) a change in the formal definition, (2) a change of tests, or (3) a shift of the implicit threshold.

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    1 Comment for this article
    Personlized medicine
    Olga Vasylyeva, MD | RGH
    A very insightful and thoughtful review. In my opinion, waste, overtreatment, and biased statistics due to a changed definition is only a consequence of medicine “protocolization,” an attempt to provide strict algorithms of management in a manner of “one size fits all.”

    With all the benefits of this approach (avoidance of misjudgment and reinforcing scientific data for one), I believe the future is personalized medicine. Personalizef medicine embraces fluidity of definitions and classifications.

    Another comment is on risk information that “does not change health-related behavior.” The mentioned systematic review included limited variety of methods. Merely providing information
    on risk and consequences might not be enough to modify behavior for some people (though for some it may be enough). There are intriguing data available on using incentives, for example.