Dartmouth and VA researchers Gil Welch, Steve Woloshin and Lisa Schwartz have an essay in the New York Times that begins: "For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system."
They go on to state: "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." They describe the "medicalization of everyday life," wherein "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."
They look at increasing questionable use of CT scans, ultrasounds, M.R.I. and PET scans.
And they address the lower thresholds for defining 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."
They conclude: "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."
Posted by schwitz at January 2, 2007 08:30 AM | TrackBack