Against diagnosis Journal Article
| Authors: | Vickers, A. J.; Basch, E.; Kattan, M. W. |
| Article Title: | Against diagnosis |
| Abstract: | The act of diagnosis requires that patients be placed in a binary category of either having or not having a certain disease. Accordingly, the diseases of particular concern for industrialized countries - such as type 2 diabetes, obesity, or depression - require that a somewhat arbitrary cut-point be chosen on a continuous scale of measurement (for example, a fasting glucose level >6.9 mmol/L [>125 mg/dL] for type 2 diabetes). These cut-points do not adequately reflect disease biology, may inappropriately treat patients on either side of the cut-point as 2 homogenous risk groups, fail to incorporate other risk factors, and are invariable to patient preference. This article discusses risk prediction as an alternative to diagnosis: Patient risk factors (blood pressure, age) are combined into a single statistical model (risk for a cardiovascular event within 10 years) and the results are used in shared decision making about possible treatments. The authors compare and contrast the diagnostic and risk prediction approaches and attempt to identify the types of medical problem to which each is best suited. © 2008 American College of Physicians. |
| Keywords: | hepatitis; cancer risk; treatment planning; clinical practice; biological marker; diagnostic procedure; breast cancer; mastectomy; heart disease; inflammation; obesity; smoking; brca2 protein; prediction; groups by age; risk assessment; depression; models, statistical; cardiovascular risk; diagnosis; glucose blood level; short survey; rating scale; clinical decision making; cholesterol; glucose; cholesterol blood level; blood pressure; statistical model; non insulin dependent diabetes mellitus; hyperlipidemia; diet restriction; marker gene; syphilis; intrahepatic cholestasis; industrialization; morbid obesity |
| Journal Title: | Annals of Internal Medicine |
| Volume: | 149 |
| Issue: | 3 |
| ISSN: | 0003-4819 |
| Publisher: | American College of Physicians |
| Date Published: | 2008-08-05 |
| Start Page: | 200 |
| End Page: | 203 |
| Language: | English |
| PUBMED: | 18678847 |
| PROVIDER: | scopus |
| PMCID: | PMC2677291 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 18" - "Export Date: 17 November 2011" - "CODEN: AIMEA" - "Source: Scopus" |
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