New emphasis on preventative medicine (diagnosing and treating “pre-disease”) is starting to look a lot like the emphasis on “holistic” health care and self-care.
In a 5/2/05 article entitled “Healthy? Think Again: New ways of diagnosing illness are changing the rules of medicine. How to sort out what it all means” by Katherine Hobson on www.usnews.com, clinicians are quoted diagnosing such conditions as “‘prediabetic’–that is, at increased risk of developing diabetes.”
The result? “Overnight, people who had never considered themselves sick were being told by their doctors that they had a medical problem.”
The new era of ultra-preventative medicine has pros and cons. The upside is better disease prevention, a goal of holistic health care; the downside, increased anxiety. According to the article: “The rules are changing everywhere. The threshold for prehypertension–worrisome blood pressure–has been lowered. So has the level of cholesterol that should be treated with statin drugs. Today, doctors routinely diagnose–and treat–a condition called osteopenia, a precursor to osteoporosis. Oncologists now treat cancer, often aggressively, at such early stages that it isn’t even cancer, just an abnormal state that may–or may not–progress to the disease. Throw in conditions like mild asthma, which until just weeks ago was commonly treated by a daily dose of steroids, and being sick suddenly begins to look like the new normalcy. Consider: The new definition of prediabetes alone means that 40 percent of adults between the ages of 40 and 74 now have the condition, while the definition of prehypertension slapped that label on 45 million Americans.”
Clinicians are “redefining disease,” sweeping millions from the “healthy” to the “diseased” category. Critics would argue this is conventional medicine’s emphasis on “disease care,” labeling individuals as their illnesses rather than treating the whole person. But the upside potential is to identify risk factors and change behaviors a lot earlier, improving potential for self-care that can reduce the chance of serious illness.
Consider this quote from the article: “I turn to [patients] and say, ‘Your sugar is elevated, and if you do nothing about it, you may progress to diabetes,’ ” says James Dudl, a physician with Kaiser Permanente in San Diego. “‘But if you would lose 7 percent of your body weight and exercise five days a week, there’s a 58 percent chance of keeping diabetes away at least for a few years.”
No matter how you slice it, it comes up lifestyle – a core tenet of complementary care. As the article points out: “With many diseases influenced by lifestyle choices–diet, exercise, tobacco use–early warnings can be a vital wake-up call.”
There are also implications for informed consent — more conversations about risks and benefits, and the lifestyle choices than can change the balance:
“…patients and doctors are going to have to get used to more complicated conversations about risks and benefits. One example: the prostate-specific antigen test. Despite its unproven accuracy, the PSA test is widely used to screen for prostate cancer. More recently, however, more doctors are debating when its use is and isn’t appropriate….With life possibly hanging in the balance, none of this, of course, is easy. But given the number of people now diagnosed as “sick” because of preconditions and the enormous costs associated with their treatment, many physicians say they can’t afford not to ask the hard questions. The rewards of early detection of disease have long been clear. For now, however, we are only beginning to come to grips with the risks and the costs.”
The model of shared decision-making, championed in the recent Institute of Medicine Report on Complementary and Alternative Medicine, looks more and more realistic given the acknowledged importance of patient participation in the healing process.