Diagnoses clog American's lives

[Guest guest]

I just read this in the newspaper today and thought I would pass it

along.

Marci

Diagnoses clog Americans' lives

By H. Gilbert Welch, Schwartz and Woloshin

New York Times News Service

EDITOR'S NOTE: Dr. Welch is the author of " Should I Be Tested for

Cancer? Maybe Not and Here's Why " (University of California Press).

Dr. Schwartz and Dr. Woloshin are senior research associates at the

VA Outcomes Group in White River Junction, Vt.

For most Americans, the biggest health threat is not avian

flu, West Nile or mad cow disease. It's our health-care system.

You might think this is because doctors make mistakes (we do

make mistakes). But you can't be a victim of medical error if you

are not in the system. The larger threat posed by American medicine

is that more and more of us are being drawn into the system not

because of an epidemic of disease, but because of an epidemic of

diagnoses.

Americans live longer than ever, yet more of us are told we

are sick.

How can this be? One reason is that we devote more resources

to medical care than any other country. Some of this investment is

productive, curing disease and alleviating suffering. But it also

leads to more diagnoses, a trend that has become an epidemic.

This epidemic is a threat to your health. It has two distinct

sources. One is the medicalization of everyday life. Most of us

experience physical or emotional sensations we don't like, and in

the past, this was considered a part of life. Increasingly, however,

such sensations are considered symptoms of disease. Everyday

experiences like insomnia, sadness, twitchy legs and impaired sex

drive now become diagnoses: sleep disorder, depression, restless leg

syndrome and sexual dysfunction.

Perhaps most worrisome is the medicalization of childhood. If

children cough after exercising, they have asthma; if they have

trouble reading, they are dyslexic; if they are unhappy, they are

depressed; and if they alternate between unhappiness and liveliness,

they have bipolar disorder. While these diagnoses may benefit the

few with severe symptoms, one has to wonder about the effect on the

many whose symptoms are mild, intermittent or transient.

The other source is the drive to find disease early. While

diagnoses used to be reserved for serious illness, we now diagnose

illness in people who have no symptoms at all, those with so-called

predisease or those " at risk. "

Two developments accelerate this process. First, advanced

technology allows doctors to look really hard for things to be

wrong. We can detect trace molecules in the blood. We can direct

fiber-optic devices into every orifice. And CT scans, ultrasounds,

MRI and PET scans let doctors define subtle structural defects deep

inside the body. These technologies make it possible to give a

diagnosis to just about everybody: arthritis in people without joint

pain, stomach damage in people without heartburn and prostate cancer

in more than a million people who, but for testing, would have lived

as long without being a cancer patient.

Second, the rules are changing. Expert panels constantly

expand what constitutes disease: Thresholds for diagnosing diabetes,

hypertension, osteoporosis and obesity have all fallen in the last

few years. The criterion for normal cholesterol has dropped multiple

times. With these changes, disease can now be diagnosed in more than

half the population.

Most of us assume that all this additional diagnosis can only

be beneficial. And some of it is. But at the extreme, the logic of

early detection is absurd. If more than half of us are sick, what

does it mean to be normal? Many more of us harbor " predisease " than

will ever get disease, and all of us are " at risk. " The

medicalization of everyday life is no less problematic. Exactly

what are we doing to our children when 40 percent of summer

campers are on one or more chronic prescription medications?

No one should take the process of making people into patients

lightly. There are real drawbacks. Simply labeling people as

diseased can make them feel anxious and vulnerable — a particular

concern in children.

But the real problem with the epidemic of diagnoses is that it

leads to an epidemic of treatments. Not all treatments have

important benefits, but almost all can have harms. Sometimes the

harms are known, but often the harms of new therapies take years to

emerge — after many have been exposed. For the severely ill, these

harms generally pale relative to the potential benefits. But for

those experiencing mild symptoms, the harms become much more

relevant. And for the many labeled as having predisease or as

being " at risk " but destined to remain healthy, treatment can only

cause harm.

The epidemic of diagnoses has many causes. More diagnoses mean

more money for drug manufacturers, hospitals, physicians and disease

advocacy groups. Researchers, and even the disease-based

organization of the National Institutes of Health, secure their

stature (and financing) by promoting the detection of " their "

disease. Medico-legal concerns also drive the epidemic. While

failing to make a diagnosis can result in lawsuits, there are no

corresponding penalties for overdiagnosis. Thus, the path of least

resistance for clinicians is to diagnose liberally — even when we

wonder if doing so really helps our patients.

As more of us are being told we are sick, fewer of us are

being told we are well. People need to think hard about the benefits

and risks of increased diagnosis: The fundamental question they face

is whether or not to become a patient. And doctors need to remember

the value of reassuring people that they are not sick. Perhaps

someone should start monitoring a new health metric: the proportion

of the population not requiring medical care. And the National

Institutes of Health could propose a new goal for medical

researchers: reduce the need for medical services, not increase it.

[Guest guest]

Could you send the url for this? Thanks.

Anita

marcitrix <marcitrix@...> wrote:

I just read this in the newspaper today and thought I would pass it

along.

Marci

Diagnoses clog Americans' lives

By H. Gilbert Welch, Schwartz and Woloshin

New York Times News Service

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[Guest guest]

Here is the url from the article, sorry I didn't include it last time

http://deseretnews.com/dn/view2/1,4382,650219648,00.html?textfield=diagnosis+

Marci

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