Does mission creep in medical diagnosis serve a public interest?

I have recently suffered from the symptoms of “Cable Creep”. This is when you look at your cable service bill – for TV, broadband, and phone line – and realise that you have accepted various upgrades to various parts of your digital uptake through various inducements and have ended up paying more than you want…for much more than you actually need.“Cable Creep” is a relatively benign condition, only causing mild perplexity to your monetary calculations and an acute but brief sense of dizziness in your monthly budget analysis. But is there a cure? Yes, there is a new pill on the market called an antigullibleolis that stops you from saying ‘yes’ to alluring digital carrots being dangled before your eyes.I wish…!

So, okay.  Nobody is offering a drug to curb digital allurement induced overuse of your purchasing power. I guess I just have to call up the cable company and politely convince them that they might want to consider squeezing me back into a previous package that actually fitted my needs – or else wave goodbye to a (previously) loyal customer when contract renewal time comes along!But the lowering of the threshold of what is considered to constitute a disease that triggers a perceived need for medical treatment has been falling over time to a point where the above treatment may not be too far off!  In fact many medical commentators are now saying the threshold is way too low for…well, for the good of the public’s health!Here in the UK – under a categorisation of “Medicalisation” – the peer reviewed British Medical Journal has just published an article called A new deal on disease definition by Ray Moynihan, who is “an author, journalist, and conjoint lecturer”.In his fascinating written diagnosis of the state of medical diagnosis today, the author reports:

…a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit.2

An equally forthright opinion piece in the LA Times by H. Gilbert Welch - a practising physician who is also a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice - concurs.  His article,Diagnosis as disease points out:

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? Diagnostic thresholds that are set too low lead in turn to a bigger problem: treatment thresholds that are too low…

And he goes on to give examples of why:…low thresholds have a way of leading to treatments that are worse than the disease. Dr Welch is also author of Overdiagnosed: Making People Sick in the Pursuit of Health, which has received mostly 5-star reviews in the customer review pages on Amazon.com.While “Cable Creep” might not exist as a disease, “Mission creep” does exist as a problem in many well-meaning problem-solving endeavours, from military interventions to welfare dependency. Is medical diagnosis another well-intentioned activity that is creeping beyond society’s comfort level?As someone who has not had a medical diagnosis for over 30 years now, due to a different healthcare choice – spiritual care – I am perhaps not best placed to comment on different gradations of such diagnosis…However, I am in a position to comment on how liberating it has been to me to exchange the medical diagnoses of my youth and early twenties – which I found could induce fear and frustration and fan the flames of self-consciousness – for what I would call a spiritual self-awareness that pays attention to the need, but seeks to address it through spiritual avenues.The heartening thing that you learn through this approach is that health really is the norm! Knowing this, and knowing how to evidence it in good health is surely what we all want, need and deserve, rather than lowering thresholds for the definition of disease.For the sake of the improved health that everyone is so fervently seeking, let’s hope that any medical diagnosis mission creep…might just creep right back!