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Healthy Skepticism Library item: 11261

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Hickie I.
Head to head: Is depression overdiagnosed? No
BMJ 2007 Aug 18; 335:(7615):329
http://www.bmj.com/cgi/content/full/335/7615/329


Abstract:

Rates of diagnosis of depression have risen steeply in recent years. Gordon Parker believes this is because current criteria are medicalising sadness, but Ian Hickie argues that many people are still missing out on lifesaving treatment

It is appropriate for the wider community to ask if the benefit of the huge increase in the treatment of depression over the past 15 years has outweighed any harm. If increased treatment has led to demonstrable benefits, and is cost effective, then depression is not yet being overdiagnosed. From a health and economic perspective, we can give a clear answer-more adults are alive and well, and we can easily afford to treat more. Increased treatment of depression reduces suicides1 2 and increases productivity.3 The provision of appropriate medical and psychological care is also cost effective.4

The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care.5 We have at last abandoned . . .

Caveats and concerns

New clinical model

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909