On January 2, The New York Times published an essay about an “epidemic of diagnosis” that is now plaguing America. The relatively short piece (893 words) was written by three doctors. The logistics are beyond us (did they alternate paragraphs? Sentences? Syllables?), but I guess once you’re in a group practice, it’s hard to shake the habit.
At any rate, the authors contend that increasing numbers of Americans are being drawn into the health care system not because of an epidemic of disease but because of an epidemic of diagnoses. We have “medicalized” everyday life, the authors write, so that experiences like insomnia or sadness are diagnosed as sleep disorder and depression. This leads to a smorgasbord of treatments, some of which aren’t so good. Moreover, advanced technology allows us to identify more people “at risk” for disease, which may not prevent onset but will promote anxiety.
The authors make some valid points – “exactly what are we doing when 40 percent of our summer campers are on one or more chronic prescription medications” – but when they complain that the “threshold” for too many diseases has been lowered, they miss the mark by lumping diabetes into that group.
It’s true that several years ago, the American Diabetes Association lowered its definition of “impaired glucose fasting” to 100 mg/Dl from 110 mg/Dl, thereby increasing the number of “pre-diabetic” patients by scientific fiat. According to the ADA, 54 million Americans now have pre-diabetes, the numbers, of course, driven by obesity, sedentary lifestyles, and aging.
The Times’ writers argue that “for the many labeled as having pre-disease. . .but destined to remain healthy, treatment can only cause harm,” but that is clearly not the case with diabetes. In fact, the problem in type 2 diabetes is the opposite: too few individuals recognize their risks and modify their lifestyles (or, to be more blunt, lose weight) as protection against the hyperglycemic train that’s heading their way. Indeed, the CDC estimates that at least five million Americans have full-blown diabetes but have not been diagnosed.
Contrary to the collective wisdom of the Times’ scribes, the problem with diabetes is that it is under-reported, under-recognized, and under-appreciated. A fourth writer, perhaps, should have been consulted.
-- James S. Hirsch