Defining terms: overmedicalisation, pathologising, overdiagnosis, overtreatment, paramedicalisation, and low value care in breastfeeding medicine

Why definitions matter

"Definitions are important, as how we label a condition can determine how society perceives, manages, and supports patients. Continuously expanding disease criteria can reduce underdiagnosis and increase appropriate care, but often risk overdiagnosis, resulting in overtreatment and low-value care, ultimately threatening health care sustainability." Tikkenen et al 2025

In contemporary practice of breastfeeding medicine, new diagnoses are often invented by breastfeeding medicine educators or International Board Certified Lactation Consultants, who may have limited experience in generalist medical or healthcare practice. (Generalist medical practitioners are experienced in, and trained to operate within, complexity, uncertainty, and the inherent risks of simplistic labels.)

These new diagnoses frequently apply highly specialised or reductionist medical lenses to a physical problem or to normal trait variation or to certain behaviours. New diagnoses rapidly spread internationally without accountability, as a result of the sociocultural belief that 'more is better', and that a new diagnosis must inevitably help breastfeeding patients and advance science. New diagnoses are typically viewed as 'cutting edge' and evidence-based, despite absence of an evidence base or strong theoretical frame.

The definitions of new diagnoses introduced by prominent individuals or groups into breastfeeding medicine and clinical lactation support are typically not carefully or scientifically analysed; the benefits of the new diagnosis are usually not scientifically established (although everyone claims that their work is evidence-based); and the risks of overdiagnosis and overtreatment as a result of these new diagnoses are not appropriately considered.

Underdiagnosis: a symptom of global inequity in health care provision

Underdiagnosis and undertreatment remain global problems in socioeconomically disadvantaged communities, predominantly in low and middle income countries, but also in vulnerable populations in high income countries. Equaity in medical care is a human right.

According to the World Health Organisation:

"Equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual orientation). Health is a fundamental human right. Health equity is achieved when everyone can attain their full potential for health and well-being."

An example from breastfeeding medicine

For many years, diagnoses of true or classic ankyloglossia were not picked up, resulting in unnecessary breastfeeding distress for both mother and baby, or in premature weaning.

Misdiagnosis

A misdiagnosis is an inaccurate diagnosis of an illness or problem.

An example from breastfeeding medicine

Many of the unhelpful diagnoses in the field of clinical breastfeeding support are misdiagnoses rather than pathologisation. Examples include the diagnoses lymphoedema for inflammatory stromal interstitial fluid; neuropathic or nociplastic or central sensitisation for persistent nipple pain; Dysphoric Milk Ejection Reflex for persistent nipple pain and associated aversive feelings.

An example from management of unsettled infant behaviour

Health systems continue to misdiagnose the disruptive effects of biomechanical problems during breastfeeding (maternal pain, infant fussiness at breast) as medical conditions e.g. infant allergy or gut pain, chronic neuropathic nipple pain.

Overmedicalisation and pathologising or pathologisation

Medicalization is the process by which nonmedical problems become defined and treated as medical problems often requiring medical treatment. International Encyclopedia of the Social & Behavioral Sciences 2015, Peter Conrad and Meredith Bergey

Pathologization is the act of representing something or someone, especially a behaviour or condition, as abnormal or diseased, especially in a medical or psychological context. It involves viewing behaviors, conditions, or even normal human experiences as inherently problematic or pathological. Google AI

Overmedicalisation is the reinterpretation of human experiences as medical problems, without net clinical benefit. "Overmedicalization refers to non-validated medical practices, with no clear benefits, potentially harmful and therefore unnecessarily costly." Hanslik & Flahault 2016

Examples from breastfeeding medicine

Labelling a labial frenulum as a lip-tie or lingual frenulum in the absence of classic tongue-tie as ankyloglossia pathologises or medicalises ordinary anatomic variability. Labelling fussy behaviour at the breast as allergy, food protein intolerance, reflux, or lactose intolerance is medicalisation or pathologisation of a behavioural communication and associated sympathetic nervous system hyperarousal. The behavioural communication needs to be taken very seriously, and addressed, but is not a sign of a medical condition.

Overdiagnosis

"Overdiagnosis describes a diagnosis that doesn’t benefit the person in question and makes people into patients unnecessarily." Davies & Salisbury

"Overdiagnosis, related to medicalization, labels conditions that would never have caused symptoms or shortened life as diseases." Tikkenen et al 2025

Overdiagnosis includes the creation of pseudo-diseases and expanded disease definitions, which lack clinical benefit.

Examples from breastfeeding medicine

Overdiagnoses of conditions for which the diagnosis lacks clinical relevance include

• Subacute mastitis

• Inflammatory vs infective mastitis

• Infected galactocoele.

Overtreatment or overuse or medical overactivity

"Overuse is the provision of health services that are more likely to harm than benefit patient." Kate & Korenstein 2018

In overtreatment or overuse, excess medication, procedures, or intervention is provided for either a correct diagnosis or a misdiagnosis.

• Overtreatment is a treatment that does not benefit the patient and can be labelled together with over-testing and overdiagnosis as medical overactivity. In a 2024 survey of 2,716 paediatricians or paediatric residents from 16 European countries and Japan found that 81% reported a frequent problem with medical overactivity.

• Overtreatment is a therapeutic intervention for which potential harm outweighs potential benefit. A pattern of overdiagnosis leads to overtreatment including poor antibiotic stewardship. 8

Examples in the field of breastfeeding medicine and management of unsettled infant behaviour

Overtreatment of breastfeeding pairs and unsettled infants is currently widespread. At the same time, there are significant health system blind spots concerning appropriate treatments for these problems, including a widespread health system blind spot concerning fit and hold.

Paramedicalisation

The following two paragraphs are adapted from Google AI translation and summary in English of Rynnanen & Myllykangas 2003 (published in Finnish)

Paramedicalisation refers to the increasing influence and application of complementary and alternative medicine (CAM) alongside or instead of conventional, biomedical approaches in healthcare. It involves the expansion of CAM into various aspects of life, often with the perception that these practices are equally or more valuable than those backed by evidence or by medical science. It's argued that paramedicalisation can result in non-medical problems being inappropriately framed as medical issues.

Despite lacking scientific validation, the popularity or paramedicalised interventions is increasing rapidly, partly due to aggressive marketing and growing societal distrust in science and institutional medical authority. Commercial motives play a central role in this trend, with many treatments marketed under the guise of pseudoscientific innovation. Rynnanen & Myllykangas warned in 2003 that paramedicalisation is not without harm. Misleading advertisements, unregulated products, and unsupervised treatments can pose real health risks. The spread of these practices within public healthcare systems - often justified by consumer demand - diverts resources from scientifically validated care.

Examples in the field of breastfeeding medicine

With the advent of our bodywork therapists into the care of breastfeeding infants, paramedicalisation has become a dominant trend in clinical breastfeeding support. NDC or the Possums programs both acknowledges the importance of the principles which underlie bodywork therapy, and proposes evolutionary bodwork, which uses these principles to offer the gestalt method of fit and hold and the NDC 8 step approach to the support of infant motor development.

Low value care

Low value care is the provision of health services which are wasteful or provide little or no benefit to patients. Any benefit from low value care is disproportionately low relative to financial cost.

It is estimated that 30% of health care provided internationally is of low value.

Examples in the field of breastfeeding medicine

A great deal of the care breastfeeding women and their infants receive is low value care, yet paradoxically comes at great health system and family expense. In Australia, for example, the health system (both publicly and privately funded) is heavily resourced with health professionals trained to support families with infants.

In my estimate, much more than 30% of this care is ineffective, lacking both an evidence-base and biological rationale. A concerning amount of the care breastfeeding women and their babies receive places them at risk of unintended outcomes.

Selected references

Andrews J. Barriers to reforming low-value care. Medical Journal of Australia. 2016;5:187.

Armstrong N. Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research. BMJ Quality and Safety. 2018;27:571-574.

Davies E, Salisbury H. How do we talk about overdiagnosis of mental health conditions without dismissing people's suffering? BMJ. 2025;389:r669.

Hanslik T, Flahault A. Overmedicalization: when too much medicine harms. Rev Med Interne. 2016;37(3):201-205.

Jankauskaite L, Wyder C, Del Torso S. Over-investigation and overtreatment in pediatrics: a survey from the European Academy of Paediatrics and Japan Pediatric Society. Frontiers in Pediatrics. 2024;12(1333239):doi: 10.3389/fped.2024.1333239.

Kate MS, Korenstein D. Overdiagnosis in primary care: framing the problem and finding solutions. BMJ. 2018;362:k2820.

Rynnanen O-P, Myllykangas M. Paramedicalisation. Duodecim. 2003;119(19):1874-1880.

Tikkinen KA, Halme ALE, guyatt GH, Gasziou P. The impact of definitions of disease on overdiagnosis. JAMA Internal Medicine. 2025:doi:10.1001/jamainternmed.2025.1727.

Tuomainen R, Elo J, Myllykangas M. Paramedikalisaatio - terveystyötä lääketieteen katveessa. Sosiaalilääketieteellinen aikakauslehti. 1995;32(3):217-223.

Treadwell J, McCartney M. Overdiagnosis and overtreatment: generalists - it's time for a grassroots revolution. Journal of General Practice. 2016;66(644):116-117.