{
  "abstract": "The overarching goal of medicine is to provide effective healthcare while minimising harms and costs from diagnoses, tests and treatments. However, approximately 10% of healthcare is considered harmful, and 30% low value—defined as wasteful, duplicative or when harms and costs outweigh the benefits. 1 2 Interventions with little to no net benefits can be classified as too much medicine and encompass overdiagnosis, broadly defined as diagnoses that reclassify healthy people with mild problems or at low risk of disease as sick.3 Too much medicine may vary across contexts, but examples may include routine use of full panel blood tests, antimicrobial agents for adults with uncomplicated acute respiratory tract infections, imaging for acute non-traumatic low back pain or cancer screening in older adults. Benefits generally receive more attention than harms in medical decision-making and research, hindering the evaluation of safety4 and resulting in an overemphasis of benefits compared with harms in clinical and health policy decisions.4–6 There is also evidence that patients and clinicians tend to overestimate benefits and underestimate harms, which may contribute to the uptake of too much medicine.7 8 If harms are considered, the focus is commonly on harm to the patient,9–11 while the burden on practitioners, the public and the planet receives less recognition. To achieve a more balanced and comprehensive evaluation of healthcare effects and thus optimise health and healthcare delivery, a systematic approach to considering harms at multiple levels is needed.",
  "authors": [
    {
      "affiliations": [
        "Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark",
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA"
      ],
      "name": "Emma Grundtvig Gram"
    },
    {
      "affiliations": [
        "Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Romi Haas"
    },
    {
      "affiliations": [
        "General Practice, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Global Center for Sustainable Healthcare, Gothenburg, Sweden"
      ],
      "name": "Amanda Niklasson"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA",
        "Center for Medicine and the Media, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth University, Lebanon, New Hampshire, USA"
      ],
      "name": "Steven Woloshin"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA"
      ],
      "name": "Barnett Kramer"
    },
    {
      "affiliations": [
        "Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "John Brodersen"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA",
        "Cochrane Denmark, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Karsten Juhl Jørgensen"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA",
        "General Practice, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden",
        "Global Center for Sustainable Healthcare, Gothenburg, Sweden"
      ],
      "name": "Minna Johansson"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA",
        "Minneapolis VA Center for Care Delivery and Outcomes Research, Minneapolis, Minnesota, USA"
      ],
      "name": "Timothy Wilt"
    },
    {
      "affiliations": [
        "Lisa Schwartz Foundation for Truth in Medicine, Norwich, Connecticut, USA",
        "Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Katy Bell"
    },
    {
      "affiliations": [],
      "name": "on behalf of the Preventing Overdiagnosis Research Day group"
    }
  ],
  "title": "Less is more for patients, practitioners, public and planet: a taxonomy for the harms of too much medicine",
  "uid": "a0e80fb2-2763-5779-89cf-bc3398d34055"
}