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Diagnosis as disease
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| Parent(s) |
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| Contributor | RP |
| Last Edited | RP May 09, 2011 10:34am |
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| Category | Editorial |
| Author | H. Gilbert Welch |
| Media | Newspaper - Los Angeles Times |
| News Date | Friday, May 6, 2011 04:00:00 PM UTC0:0 |
| Description | The threshold for diagnosis has fallen too low. Physicians are now making diagnoses in individuals who wouldn't have been considered sick in the past.
Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is).
Low diagnostic thresholds lead people who feel well to be labeled as unwell. Not surprisingly, some subsequently feel less well. In short, low diagnostic thresholds introduce more "dis"-ease into the population. Does that sound like a good thing for a "healthcare" system to do?
Another way to look at it is this: These marginal patients are at extremely high risk not to benefit from treatment.
Yet they face the same risk of harm from treatment. One common treatment for osteopenia can lead to ulcers in the esophagus and may even make bones more brittle with long-term use. The common treatment for prostate cancer leads many men to become impotent and/or develop bowel and bladder problems.
In short, low thresholds have a way of leading to treatments that are worse than the disease. |
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