Australia is responding to the complex challenge of overdiagnosis

In reply: We thank Molodysky and Mendelson for their comments on our article on Australia's emerging response to the health challenge of overdiagnosis,1 and welcome the discussion and public debate about these issues.2

In response to Molodysky's letter about prediabetes, and the enthusiasm for a new wave of diagnosing preclinical disease, we would argue that the mounting evidence about overdiagnosis shows, as a general rule, that early detection is a double‐edged sword.3 Early detection means that some people experience the benefits of having genuine pathology detected or prevented, while others are labelled and treated unnecessarily. We believe these generic concerns about the downsides of early detection are also applicable to the detection of prediabetes, a controversial diagnostic category that, as others have pointed out, could be described as a “risk factor for developing a risk factor”.4 There is concern too about the lack of agreement on the definition of prediabetes, the poor accuracy of tests, and whether, in relation to screening, the possible benefits outweigh the harms and costs.5

We fear that any major injection of resources targeting the underdiagnosis of preclinical disease could greatly benefit people selling and delivering diagnoses and treatments, while causing harm to many of the individuals subsequently overdiagnosed, and further undermining the sustainability of our universal publicly funded Medicare health system.

In response to Mendelson's comments about psychiatric conditions, we agree there is a need for much greater investigation of the overdiagnosis of mental disorders, and we would welcome abstracts around this topic at the 2019 Preventing Overdiagnosis conference. As Australia's Chief Medical Officer told the media in response to our MJA article,1 overdiagnosis is “a significant issue in all countries with advanced health systems” and “there is no doubt we need some sort of approach to address it”.2