Strategies to improve healthcare for an aging population

Brandenburg an der Havel, 24 October 2025

“De-escalation in the context of patient centered healthcare”, one of the key research interests at the Brandenburg Medical School Theodor Fontane (MHB), was in the focus of a kick-off symposium at the Faculty of Medicine and Psychology in Brandenburg an der Havel on 10 October 2025.

Numerous researchers and guests were present when dean Prof. Dr. Christine Holmberg, chancellor Dr. Gerrit Fleige and Prof. Dr. Konrad Schmidt from the Institute of General Medicine opened the event. Holmberg outlined the relevance of the topic for research at the MHB: de-escalation describes the targeted reduction or avoidance of unnecessary medical interventions with the intention to ensure high-quality, safe and efficient healthcare and avoid over and under provision.

Prof. Dr. Konrad Schmidt had invited Prof. Dr. John Brandt Brodersen (University of Copenhagen) and Prof. Dr. Verena Vogt from the Jena university hospital as external speakers and conducted the meeting. The program started with Prof. Brodersen’s speech on “Overdiagnosis – a driver of too much medicine”, positing the provocative thesis that 30 % of our medical procedures and services are unnecessary, and that a further 10 % are even harmful. Based on the example of reduced diagnostic threshold values such as in hypertension, he described the phenomenon of so called “disease mongering” – a tendency to interpret normal variations with no significant pathology as disorders requiring treatment. This, so his thesis, increases the number of “patients” and thus the market for medical products and services, with the result of frequent over provision, like in screening programs for malignant melanoma or prostate carcinoma in the general population. According to Brodersen there is no evidence of reduced morbidity or mortality, and damage to health may even be accepted as a possible risk. He identified the so called “Health Culture”, the maximum of medical services despite an ultimate mortality of 100 %, as a postmodern paradox and the underlying economic and cultural driving force. His lecture resulted in a lively debate, which Prof. Broderson extended with several explanatory approaches in an improvised flip chart session.    

The presentation of Prof. Dr. Verena Vogt, member of the Federal Health Ministry’s new finance committee, was more concerned with the actual realities of care provision in Germany. Referring to routine data provided by insurers, she reported disturbing quantities of medical services nationwide with questionable benefits, such as unnecessary laboratory tests or administration of benzodiazepines. She underlined the need to address this “uncomfortable” issue since Germany has the highest health costs all over Europe, but no higher life expectancy compared to other EU states. Definitions of over and also underprovision require a differentiated analysis of indicators and conditions for better management incentives at many levels. This speech was also followed by a vivid discussion which continued during the coffee break with an exchange on MHB plans for a poster exhibition.  

In the second part of the symposium, MHB researchers presented their own concepts and projects: Prof. Dr. Oliver Zolk from the Rüdersdorf Institute of Clinical Pharmacology described the phenomenon of multi-medication and the chances and obstacles involved in “deprescribing”, i.e. the systematic reduction of unnecessary medication. Prof. Dr. Michael Hauptmann from the Neuruppin Institute of Biochemistry and Registry Research illustrated “de-escalation” as a strategy in cancer research to individually assess and select oncology therapies after a harm-benefit analysis.

A small group of participants went on to discuss the lectures and the further implementation of the topic at the MHB. An extended work group is going to pursue the work in support of MHB research projects in the context of health services research. A further exchange on the subject of de-escalation is planned for the next Faculty Council meeting on 20 November 2025. Individuals with an interest in the topic are invited to join in and may directly contact our Department for Research and Academic Affairs.