Medical Luddites?

Perhaps the most significant change in my lifetime has been the advances in medicine. However, despite these advances, most of us still experience pain and discomfort. When I was growing up these minor pains and aches were considered a normal part of life. Now we worry that today's pain might be a sign that tomorrow we'll develop a serious illness. So, we visit the doctor who, using advanced diagnostic procedures, may conclude that we are at risk for a particular condition somewhere down the line. And, so you change your status from normal person to patient.

It is the number of people who change that status that is at the heart of an argument made by three doctors in yesterday's NY Times that we are over-diagnosed. In their view, over-diagnosis is what puts many people - who would have been considered normal years ago - into the medical system, creating the over-burdened medical system we have today.

Obviously, the authors are not arguing against modern diagnostic techniques. However, they do make the point that these techniques can discover conditions which may or may not lead to a particular disease. It's the 'may not' that worries the authors; many of us in our lifetime will not get a disease for which a diagnosis indicates we are at risk, we'll die from something else.

Interestingly, they claim that the thresholds for diagnosing certain diseases has dropped considerably over the years. In fact, they've dropped so far that diseases can now be diagnosed in more than half the population. If that is the case, less than half of us would be considered normal relative to illness.

Over-diagnosis may be greatest relative to our children. For example, the authors claim that 40% of summer campers use one or more chronic prescription medications.

One could argue that I'd rather be safe than sorry. But does such an argument apply to society at large? It applies in Lake Woebegone where all the children are above average. I don't think it applies in real life.