HEALTHCARE IS MAKING US SICK

H. GILBERT WELCH, LISA SCHWARTZ AND STEVEN WOLOSHIN, NY TIMES - For
most Americans, the biggest health threat is not avian flu, West Nile or
mad cow disease. It's our health-care system. You might think this is
because doctors make mistakes (we do make mistakes). But you can't be a
victim of medical error if you are not in the system. The larger threat
posed by American medicine is that 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. Americans live longer than ever, yet more of us
are told we are sick. How can this be? One reason is that we devote more
resources to medical care than any other country. Some of this
investment is productive, curing disease and alleviating suffering. But
it also leads to more diagnoses, a trend that has become an epidemic.

This epidemic is a threat to your health. It has two distinct sources.
One is the medicalization of everyday life. Most of us experience
physical or emotional sensations we don't like, and in the past, this
was considered a part of life. Increasingly, however, such sensations
are considered symptoms of disease. 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.

The other source is the drive to find disease early. While diagnoses
used to be reserved for serious illness, we now diagnose illness in
people who have no symptoms at all, those with so-called pre-disease or
those "at risk.". . .

As more of us are being told we are sick, fewer of us are being told we
are well. People need to think hard about the benefits and risks of
increased diagnosis: the fundamental question they face is whether or
not to become a patient. And doctors need to remember the value of
reassuring people that they are not sick. 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.

Dr. Welch is the author of "Should I Be Tested for Cancer? Maybe Not and
Here's Why" (University of California Press). Dr. Schwartz and Dr.
Woloshin are senior research associates at the VA Outcomes Group in
White River Junction, Vt.

http://www.nytimes.com/2007/01/02/health/02essa.html

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