May 6, 2011

FOLLOW THE MONEY:

Diagnosis as disease: Physicians are now making diagnoses in individuals who wouldn't have been considered sick in the past, and it's raising healthcare costs. (H. Gilbert Welch, May 6, 2011, LA Times)

One of the first things we were taught in medical school was the pivotal role of thresholds in governing the human body. To trigger a nerve to fire or a muscle to contract, there must be a stimulus of electrical activity that exceeds a threshold value. If the threshold value is too low, muscles go into spasm and deadly rhythms develop in the heart.

Low thresholds, however, aren't just a problem for an individual's health. They are increasingly a problem for the health of our medical care system.

The threshold for diagnosis has fallen too low. Physicians are now making diagnoses in individuals who wouldn't have been considered sick in the past.

Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is).

Low diagnostic thresholds lead people who feel well to be labeled as unwell. Not surprisingly, some subsequently feel less well. In short, low diagnostic thresholds introduce more "dis"-ease into the population. Does that sound like a good thing for a "healthcare" system to do?


Of course, if being diseased cost you money instead of winning you cash, we'd be extraordinarily healthy.


Posted by at May 6, 2011 6:35 AM
  

blog comments powered by Disqus
« FRUIT OF THE WELL-WATERED TREE: | Main | THE ACOLYTE: »