This year seem to be flying by to anyone else?  Monday is the last day of February...where is the time going?  And speaking of where things are going...where is our healthcare system going? 

 

The Washington Post recently posted an interview on their website with the authors of a new book entitled, "Overdiagnosed: Making People Sick in the Pursuit of Health."  In the interview, the researchers and physicians that wrote the book discuss their concerns over the healthcare reform.  While they agree that reform is necessary - no one in their right mind would suggest otherwise, regardless of party lines - they just don't think that the kind of reform we're getting is going to positive. 

 

Their stance is this: we need to take preventative measures to make a real difference in healthcare.  However, the kind of prevention that the reform talks about is screenings and early detection, which is going to identify a whole host of new patients who really don't have symptoms in order to put them on medications.  Thus, it will cost more money than ever and it will turn previously asymptomatic people into symptomatic people because of the adverse side effects from the drugs. 

 

They go on to talk about how the normal values for such things as cholesterol, blood sugar, and blood pressure continue to be lowered.  When people are identified as having a related condition thanks to a reduction in normal values, it becomes problematic.  They are put on medications that they really don't need and next thing you know, there health is much worse than before.  All thanks to a warped view of the concept of "prevention."  If someone has slightly high blood pressure and are put on BP lowering meds and then get vertigo-like dizzy symptoms, what exactly was accomplished other than taking a person who just wanted a physical exam and turning them into a vertigo patient? 

 

I feel very similar about this issue as these Dartmouth authors.  The premise behind getting a system that deals with prevention in maintenance is sound, but the fundamentals are flawed.  Prevention has nothing to do with symptoms; that's the problem.  When your system is based on the idea that having symptoms = not being healthy, then there's the alpha problem.  The current system just adapts to whatever new wrinkle you put into it (i.e. lowering normal values so that you can diagnose more people with conditions and, thus, put them on medications).  Early detection is NOT prevention.  By definition, if you detect it, then that means you already have it. 

 

Prevention is all about a fundamental shift in the paradigm away from over-medicating.  Realizing that is the only way we're ever going to truly reform the system.  Bottom line.

 

Thinking good things for you, as always,

 

Dr. Chad