In an article last week in the Los Angeles Times, Dr. Gilbert Welch, a professor of medicine at the prestigious Dartmouth University (and the author of "Over-diagnosed: Making People Sick in the Pursuit of Health"), draws attention to the strange fact that in modern medicine, diagnosis itself has become a source of disease. The criteria of what constitutes sickness, the rules which define abnormality are constantly being stretched so that more and more people are being declared sick. People who would not have been considered sick a few years ago are now being considered sick for the same diagnostic measurements. For example, a fasting blood sugar level of 130 mg/dl was not considered to be diabetes before 1997, but it is now. The same reduction of thresholds (which separate the normal from the abnormal, from the "well" to the "sick") is true of all other common diseases such as high blood pressure, osteoporosis, heart disease, cancer, etc. As a result, the number of normal people made "sick" by diagnosis and the attendant medical expenditure are skyrocketing. It appears that many normal people who felt perfectly well before the diagnosis feel less well after they are diagnosed as "sick". Thus diagnosis is introducing more "dis"-ease among people!
People who have been declared "sick" by the mere reduction of thresholds have a very low probability of experiencing their "disease" in their lifetime. Nevertheless, modern medicine puts them on treatment. Benefit of the treatment is minimal for these marginal patients, but they incur the full risk of the negative effects of the treatment. Reduction of the threshold in bone density has resulted in innumerable normal women to be diagnosed as suffering from osteopenia (which is a precursor to osteoporosis). One common treatment for osteopenia can lead to ulcers in the gullet and may even make bones more brittle with long-term use. Similarly, reduction of the threshold in the PSA test has resulted in innumerable normal men to be diagnosed as suffering from prostate cancer and the common treatment for prostate cancer leads to impotence, and bowel and bladder problems. Thus the reduction of thresholds is leading to treatments that may be worse than the disease.
Dr. Welch points out some reasons for why more and more normal people are being made "sick" by diagnosis. Money is the biggest reason. The more patients there are under treatment, the more profitable it is for the doctors, the hospitals and the drug companies.
Another reason is that doctors get frequently sued for failure to diagnose and failure to treat, but one rarely gets sued for over-diagnosis or over-treatment. So over-diagnosis and over-treatment are safer options for the doctor.
Anitha Sridhar, Mysore Grahakara Parishat