Bill, a healthy looking guy in his mid-40s, came to WholeHealth Chicago because he wanted to get off Lipitor, the widely prescribed cholesterol-lowering drug. Bill had virtually no risks for heart disease and all four of his grandparents were still alive and quite independent, but a few years ago his cholesterol was on the high side and his doctor insisted on the Lipitor.<\/p>\n
Arthur has been taking a beta blocker for high blood pressure for ten years. Over that decade he became a self-described health nut, marathon runner, and Whole Foods habitu\u00e9. Arthur\u2019s now the whole enchilada of good health, but his doctor still wants him on his med.<\/p>\n
Tammi, in her late 20s, has been struggling with her thyroid hormone replacement medication. In her teens, complaining of a sensation of fullness in her neck, she had some thyroid testing and even though she felt fine was told she had an overactive thyroid and was given radioactive iodine, which wiped out her thyroid function altogether. She hasn\u2019t felt well since.<\/p>\n
Robert, now 30, had been taking Seroquel, a med for bipolar disorder, since college. \u201cI sort of acted out a lot. The psychiatrist said I was bipolar and since then everyone has been afraid to stop my med.\u201d<\/p>\n
Marisol has been taking Plaquenil and low-dose prednisone for years after a screening test for the autoimmune disease lupus revealed a positive ANA (antinuclear antibody) result. She was told she had lupus and could die without meds.<\/p>\n
Danielle has been popping Nexium (for heartburn) for as long as she can remember. Bob is scheduled for an arthroscopy because of his knee pain, Jack to have his prostate biopsied and probably \u00a0removed. Mary\u2019s anxious about the upcoming biopsy of a tiny abnormality on her mammogram. Linda has read about her upcoming LEEP procedure (removing abnormal cells from her cervix) and wonders if there are \u00a0alternatives.<\/p>\n
Believe me, the list could go on. What I\u2019ve just described are some of America\u2019s most overdiagnosed and overtreated conditions.<\/p>\n
Overdiagnosis How do we get labeled with conditions that might not be \u201cconditions\u201d at all? Tammi and her thyroid, Danielle with her Nexium, and Jack\u2019s soon-to-vanish prostate can be reduced to the same few factors:<\/p>\n Screening tests \u00a0<\/strong>Having regular checkups and being screened for frightening conditions like cancers of the breast and prostate, getting your blood pressure taken, and knowing your cholesterol levels all sound like sensible preventive measures. The problem is deciding what\u2019s worth treating and what\u2019s not. If you have consistently high blood pressure, it does need to be treated. Unfortunately, many patients have been taking unnecessary blood pressure drugs despite telling their doctors \u201cBut it\u2019s only high in your office!\u201d Tens of thousands of men had their prostate glands removed before someone did the math and found that this group\u2019s death rates from prostate cancer were the same as men who never had prostate screening at all. Countless breast surgeries have been performed on women whose mammograms were \u201csuspicious.\u201d<\/p>\n Shoddy standards for deciding what constitutes \u201cdisease\u201d \u00a0<\/strong>Psychiatry takes a lot of justifiable heat for this, and all physicians (including psychiatrists) complain that the insurance industry requires them to place a diagnosis on the insurance claim form in order to get paid. The American Psychiatric Association\u2019s DSM (Diagnostic and Statistical Manual of Mental Disorders, a standardized classification of mental disorders) makes labeling patients with bipolar disorder, ADD, or schizophrenia all too easy. Once labeled, meds follow. And once labeled, it\u2019s easier to get a tattoo removed from your forehead than to get a diagnosis expunged from your records.<\/p>\n Marisol\u2019s positive test result for ANA with absolutely no other evidence of lupus is, after 30 years, finally being appreciated as a \u201cfalse positive, no treatment needed.\u201d Danielle could start some\u00a0lifestyle changes for her GERD<\/a>\u00a0and when she feels it coming on simply mix a half teaspoon of baking soda in a little water rather than take 3,650 Nexiums (Nexia?) over the next decade.<\/p>\n Big Pharma\u00a0<\/strong>wants you diagnosed so you\u2019ll buy their product. You\u2019re assaulted with drug ads to convince you you\u2019re ill when you\u2019re actually not. This can lead to setting health goals (\u201cLower your HbA1c!\u201d) that are controversial. We physicians are flooded with questionable medical studies that, when explored in depth, have led to \u201cdiseases\u201d whose treatment will likely not add a single minute to our patients\u2019 lives. For example, the standards that allegedly established the point at which blood pressure was high enough to initiate treatment or cholesterol high enough to start a statin can be traced to industry-funded medical gatherings.\u00a0<\/strong><\/p>\n The for-profit health care system \u00a0<\/strong>Even though knee arthroscopies have been shown to have no long-term benefit and to not be any better at relieving symptoms than sham\u00a0arthroscopy<\/a>\u00a0(incision only, no arthroscopy), orthopedic surgeons still perform 700,000 a year. Despite knowing there was no drop in the number of deaths from prostate cancer with intensive PSA screening and aggressive surgical intervention, urologists performed 150,000 prostatectomies last year. When a screening test picks up early osteoporosis, you catch a double whammy. Big Pharma charges $1,200 for a single IV infusion of Reclast and the sky\u2019s the limit for the hospital IV charge. Fees ranging from $500 to $15,000 (!) have been reported by patients. Until I tossed them, I had stacks of Big Pharma\u2019s osteoporosis screening guides around the office. I remember a drug rep once asking \u201cCan you give me a reason why you wouldn\u2019t screen every woman over 40 in your practice for osteoporosis?\u201d<\/p>\n So what to do about this unsavory state of \u00a0affairs? \u2013Cultivate skepticism into an art form<\/u>\u00a0to the point where you suspend belief in the healthcare system. We use the words \u201csuspend disbelief\u201d to enjoy anything theatrical. We know in our hearts that King Kong didn\u2019t really climb the Empire State Building, but by suspending disbelief we enjoy the movie. Now you\u2019ve got to suspend your belief in a system that may not have your best interests in mind.<\/p>\n \u2013Think carefully about screening tests<\/u>. Virtually all doctors agree that annual check\u00adups aren\u2019t needed for healthy adults. You\u2019re offered them by your health insurance company because they\u2019re inexpensive and they keep you from complaining about the otherwise shoddy coverage they sell you. The folks at the popular\u00a0Life Line Screening<\/a>\u00a0never say the words \u201cnot necessary\u201d and will happily screen you for conditions you\u2019ll likely never have. Keep up with the latest guidelines on mammograms and Pap smears. If recommendations conflict with each other (first mammogram at 40 or 50), choose the one that asks you to do less rather than more.<\/p>\n \u2013Question medical authorities relentlessly<\/u>. Practice these sentences: \u201cDo I really need to do this?\u201d and \u201cDo I really need to take this?\u201d and \u201cWhat are my other options?\u201d Get second and even third \u00a0opinions.<\/p>\n \u2013If you use the internet to keep yourself informed<\/u>\u00a0(a positive, in my view), check the publication date of what you\u2019re reading. Medical flip-flopping is common. A must-have treatment in 2003 may be completely reversed in 2019. The gushing praise for PSA screening ten years ago has pretty much vanished.<\/p>\n And, of course, the very best way to avoid overdiagnosis is to keep yourself so healthy you don\u2019t really need us at all.\u00a0Here\u2019s an excellent if lengthy 2017 Atlantic article that looks closely at unnecessary and unhelpful medical treatments.<\/a>\u00a0I\u2019m quoting this section for obvious reasons, but please click through and read it all.<\/p>\n The health problems that most commonly afflict the American public are largely driven by lifestyle habits\u2014smoking, poor nutrition, and lack of physical activity, among others. In November, a team led by researchers at Massachusetts General Hospital\u00a0<\/em>pooled<\/em><\/a>\u00a0data from tens of thousands of people in four separate health studies from 1987 to 2008. They found that simple, moderate lifestyle changes dramatically reduced the risk of heart disease, the most prolific killer in the country, responsible for\u00a0<\/em>one in every four<\/em><\/a>\u00a0deaths. People deemed at high familial risk of heart disease cut their risk in half if they satisfied three of the following four criteria: didn\u2019t smoke (even if they smoked in the past); weren\u2019t obese (although they could be overweight); exercised once a week; ate more real food and less processed food. Fitting even two of those categories still substantially decreased risk. In August, a\u00a0<\/em>report<\/em><\/a>\u00a0issued by the International Agency for Research on Cancer concluded that obesity is now linked to an extraordinary variety of cancers, from thyroids and ovaries to livers and colons.<\/em><\/p>\n Be well, Bill, a healthy looking guy in his mid-40s, came to WholeHealth Chicago because he wanted to get off Lipitor, the widely prescribed cholesterol-lowering drug. Bill had virtually no risks for heart disease and all four of his grandparents were still alive and quite independent, but a few years ago his cholesterol was on the high […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3,216,2332],"tags":[],"class_list":["post-23627","post","type-post","status-publish","format-standard","hentry","category-blog","category-knowledge-base","category-p","category-preventive-medicine"],"yoast_head":"\r\n
\n<\/strong>The concept of overdiagnosis\u2013labeling patients with conditions that probably aren\u2019t particularly dangerous and initiating treatment that may be either unnecessary or do more harm than good\u2013has become a major issue. European physicians\u00a0actually convene annually to discuss strategies to reverse this worrisome trend<\/a>. A real expert on the subject is H. Gilbert Welch, MD, an internist and professor at Dartmouth Medical School, who has written two books\u00a0Overdiagnosed<\/em><\/a>\u00a0and\u00a0Less Medicine, More Health<\/em>.<\/a><\/p>\n
\n<\/strong>How can you protect yourself from unnecessary medications and surgical procedures? Here\u2019s a primer:<\/p>\n
\nDavid Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"