Blog | Tuesday, April 10, 2012

Does 'preventive medicine' harm health?

Please read this New York Times op-ed, "If You Feel O.K., Maybe You Are O.K.

The basic strategy behind early diagnosis is to encourage the well to get examined to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn't find any evidence for this in its recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly, into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms).

This process doesn't promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.

He goes on to argue that true prevention involves health behaviors, exercise, diet, avoiding cigarettes, substances of abuse, etc.

This argument makes some sense. He has it mostly correct. We do need strong secondary prevention. Once we have a diagnosis, then secondary prevention becomes important and useful.

So the argument should focus on primary prevention. Some primary prevention seems to make sense: colon cancer, measuring your blood pressure and starting treatment once the blood pressure exceeds 140/90, etc. But other primary prevention concepts do not seem to work.

We should put more money into planning that encourages walking, healthy eating and discourages smoking.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.