America's health care system suffers from an "Epidemic of Diagnoses," say cancer docs

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Dr. H. Gilbert Welch, author of "Should I Be Tested for Cancer? Maybe Not and Here's Why," and Drs. Lisa Schwartz and Steven Woloshin are all members of the VA Outcomes Group, a group of doctors, fellows and researchers who do not necessarily think that more health care means more health for Americans.

In the article, while admitting health care professionals make mistakes, the doctors say that the major threat from health care is not mistakes but a diagnosis epidemic. The motivation for this epidemic, the authors say, is likely the fact that the income of drug manufacturers, hospitals, doctors and disease nonprofits is directly proportional to the number of diagnoses made. And there are legal ramifications for not diagnosing a disease, but no such kickback exists for overdiagnosis.

The authors consider the cause of this epidemic to be what they call "the medicalization of everyday life," in which normal-yet-uncomfortable problems people experience every day are turned into diseases: Insomnia suddenly requires sleep medication, and restless legs, sadness and reduced libido are all diagnosed as real medical conditions.

The authors note that an even more disturbing trend is the overly reactive diagnosis of children, as children with chest problems are said to have asthma and unhappy children are labeled depressed, but the severity of the symptoms are rarely considered. This problem stems from good intentions, according to the authors, in which the desire for early detection in order to have the best chance of disease eradication has gotten out of control.

New technologies make the situation worse -- as they allow doctors to find traces of diseases in almost every person examined -- and the things that define a disease are also in flux. In the last few years, the "at-risk" levels for diabetes, cholesterol, hypertension, osteoporosis and obesity have all dropped, some more than once. As the authors point out, this means that more than 50 percent of the U.S. population is technically diseased.

"At the extreme, the logic of early detection is absurd," they said. "If more than half of us are sick, what does it mean to be normal?"

The natural consequence of a diagnosis epidemic is a treatment epidemic, the authors warn: Not all treatments have positive effects, but almost all of them have negative side effects, some of which are not detected until years after treatment. Even when the treatments do provide some positive effects, the authors said, they are often outweighed by the side effects, and it's even worse when a "pre-diseased" or mildly diseased person is subject to treatment side effects when he or she would have otherwise experienced few or no symptoms at all.

"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," the authors said. "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."

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