HARMING THE HEALTHY

   Our Three Minutes Consult today comes from Ray Moynihan, senior research fellow at Bond University, Queensland, Australia, and co-author of “Selling Sickness” (New York, Nation Books, (2005).  Consumer reports on Health, describes the details of “disease mongering,” which means selling disease.  One might say it is really just raising the awareness of diseases, but the other argument says it is driven by vested interests who want to maximize their markets.  Or is it turning shyness into social phobia that needs medication and call it female sexual dysfunction.

   Moynihan believes that some women are told they have a condition called osteopenia and widens the boundaries of illness to catch more healthy people to create a pre-condition such as pre-diabetes, pre-high blood pressure or pre-osteoporosis, and offer prescriptions for it, opening the door to lifelong medication use that may do more harm than the condition.

   What is over-diagnosis?” you may ask.  Some people may believe that you either have a medical condition or you don’t.  A most frightening example is breast cancer, called a ductal carcinoma in situ.  The natural history of this disease is so benign that a few years ago the National Institutes of Health suggested changing the name to get rid of the word “carcinoma.” 

   Something like that is going on with prostate cancer, which is why PSA tests for both prostate and breast cancer is that when early signs are detected, it cannot be possible to know whether that cancer will go on to kill or not.  We need to get better at distinguishing the harmful from the not-so-harmful.  Some experts suggest new approaches to very early signs of breast cancer, such as taking a “watch and wait” approach.

   Most people already know they need to have a healthy skepticism about potentially harmful treatments.  They are also going to have to become more skeptical about labels and diagnoses, because many of them may be unnecessary.  How to better communicate about over diagnosis will be the theme at an international conference being hosted next year by the Dartmouth Institute for Health Policy and Clinical Practice, in partnership with Bond University, the British Medical Journal, and Consumer Reports (preventingoverdiagnosis.net).