Monday, February 12, 2007

It's Not the Diagnosis, It's What We Do With It

Constance and Melinda were discussing a recent article in the New York Times. It may have been this one:

What's Making Us Sick Is an Epidemic of Diagnoses

It's not surprising which side of the fence I fall, especially after my last few posts on blood pressure and blood sugar testing. (I believe in early diagnosis.)

I can understand how an article such as this is born, in a culture that embraces medical technology and pharmacological therapies. "Enough with the doctors and hospitals already!" But I thought the authors came down harder on the diagnosis end of the spectrum than was warranted. I don't see that diagnoses are harmful, or are "making us sick". I do however see abuse of pills and surgery ... that sickens me.

Nipping high blood pressure, high blood sugar, cancerous lesions, excess weight, etc. in the bud - through early diagnosis - can save lives, money, and most importantly, can improve quality of life.

However, where I agree with the article is:
"More diagnoses mean more money for drug manufacturers, hospitals, physicians and disease advocacy groups."
That's a shame because many conditions, if found early, respond to inexpensive lifestyle changes.

"First, Do No Harm"

A better argument the article could have made in defense of its diagnoses-are-harmful theme, one that would have won me over, is the possible risk to health involved in invasive screening technologies, especially those involving radiation and excision of healthy tissue, including blood. Let's not even discuss the humiliating ones. (If you're over 50 and haven't had a sigmoidoscopy yet, raise your hand.) It's enough to make one forego the test.

Happily, scientists are working on less invasive technologies, for example, viewing lungs without ionizing radiation (using sound) and testing blood glucose without drawing blood (using light) Stay tuned!

Sickness is in the Eye of the Beholder

As to people viewing themselves as "sick" when they have no symptoms, e.g. in hypertension, I think this lies in perspective. The article discussed one perspective, a negative one: "Simply labeling people as diseased can make them feel anxious and vulnerable." This assumes there's only one way to view a person with a condition. I don't know what these authors' healthcare backgrounds are, but I can speak for members of the diabetic community when I say they prefer to be regarded as people ... who happen to have diabetes, not as "diabetics", and certainly not "sick".

If you are someone with fair skin that benefits from protection in the sun, do you think of yourself as diseased? If you are someone whose blood pressure benefits from less sodium and more activity, do you think of yourself as diseased? Certainly there's a spectrum of illness, but people have a choice as to how they view chronic conditions that can be successfully managed. A more optimistic and empowering view of an early diagnosis might be, "Great! I found my blood pressure beginning to inch up and can work it down by cutting back on salt and following the dog around the block."

Curiously, these authors again took a negative stance by giving the impression that treatments for early-found conditions can be harmful, "Not all treatments have important benefits, but almost all can have harms." (I get the feeling the people who wrote this have a more intimate relationship with pills than I do.) What's harmful about a walk? What's harmful about ditching the donuts? Lifestyle changes such as these have been shown to be just as effective as drugs for a number of conditions.

As I see it, there's more harm in letting a disease go undiagnosed, and having to resort to more extreme therapies when the person lands in the emergency room.

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