[The fox guarding the henhouse. Who decides diagnostic criteria?]

Abstract

To reduce overprescribing, the consequences due to the invention of new diseases and the systematic reduction of threshold values have been studied, and projects to reduce procedures of low efficacy, the number of prescribed drugs, and procedures at risk of inappropriateness have been developed. The composition of committees establishing diagnostic criteria was never addressed. To avoid this problem (de-diagnosing) four procedures should be implemented: 1) diagnostic criteria should be assigned to a committee of general practitioners, clinical specialists, experts like epidemiologists, sociologists, philosophers, psychologists, economists, and representatives of citizens and patients; 2) experts do not have relevant conflicts of interest; 3) criteria should be set up as recommendations to facilitate discussion between a physician and a patient on the decision whether to begin a treatment and not as a recommendation functional to overprescription; 4) criteria should be periodically revised to approach the process closer to the experiences and needs of physicians and patients.