Attention, please

摘要

The BMJ has long been at the forefront of drawing attention to the harms of overdiagnosis and disease mongering, and in doing so has often run up against various vested interests and awareness-raising organisations. Perhaps the trickiest areas lie in the behavioural disorders, where doctors (and patients) have to make judgments between what is an unfortunate but normal part of life and what is debilitating and socially disruptive behaviourthat may be amenable to treatment. It is possibly here-with conditions such as attention-deficit/hyperactivity disorder (ADHD)-that the perils of medicalisation are at their greatest. As Rae Thomas and colleagues write in the latest article in our "Too much medicine" campaign (p 18), prevalence and prescribing ratesfor ADHD have risen sharply over the past decade "partly in response to concerns about underdiagnosis and undertreatment." But whereas doctors have become better at recognising, diagnosing, and treating children with the disorder, 86% of children who receive a diagnosis have, according to recent data, only "mild or moderate" disorder, and some are said to have ADHD without fulfilling any of the diagnostic criteria.