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There have been many warnings that inappropriatedichotomisation of results into positive or negative, high, or normal etc.,during medical research could be very damaging. The aim of this paper is toargue that this is the main cause of over-diagnosis and over-treatment.Methods: Illustrative data were taken from a randomised control trial (RCT)that compared the frequency of nephropathy within 2 years in those on treatmentwith an angiotensin receptor blocker and a control and on patients in whom thenumerical value of the albumin excretion rate (AER) was available on allpatients before they are randomised. Results: When the RCT results were dividedinto AER ranges, a negligible proportion developed nephropathy within 2 yearsand benefited from treatment in the range 20 to 40mcg/min in which 36% ofcurrently treated patients fall (and are thus over-diagnosed and overtreated).Above an AER of 40mcg/min, there was a gradual increase in proportions withnephropathy in each range, with fewer developing nephropathy in each range onirbesartan 150mg daily than on control and fewer still developing nephropathyon 300mg daily. Interpretation: When logistic regression functions were fittedto the data and calibrated, curves were created that allowed outcomeprobabilities and absolute risk reductions to be estimated for use in shareddecision making (illustrated by application to an example patient). This couldavoid much overdiagnosis and overtreatment. Conclusion: Careful attention todisease severity by interpreting each numerical diagnostic result providesbetter application of the principles of diagnosis and treatment decisions thatcan prevent over-diagnosis and over-treatment.

Clinical dichotomania: A major cause of over-diagnosis and over-treatment?