Doctoring Health Care

What is normal and what is disease?

Future generations of doctors will face different challenges than I did. When I started training, disease was easier to spot than it is now.

Today, the line between sickness and wellness has blurred–and it gets blurrier all the time. The quantified self movement stands to make this worse.

In a profit-driven healthcare climate, disease feeds the business model. One way to drive sales of drugs and procedures is to create more diseases. And to do that, one has only to medicalize the human condition.

Why doctors (and patients) discount the resilience of the human body perplexes me.

I had the pleasure of meeting Dr. Allen Frances at a Lown Institute meeting this year. He is an emeritus professor in Psychiatry at Duke and an outspoken voice against overdiagnosis and overtreatment in mental health.

It’s less than two minutes, and it’s a metaphor for what ails much of our broken healthcare system.

Remember…When we overdiagnosis and overtreat, we have less attention and resources to treat those with real illness.


4 replies on “What is normal and what is disease?”

The “disease ” model is problematical in light of new and relevant epigenetic research that demonstrates the changes in DNA over the lifespan due to environmental, physical illness, stress and other factors. These changes are also reversible due to plasticity. I think we need to re-think how we categorize such processes as schizophrenia before we classify it as a “disease”. It is more of complex process involving genetic, environmental, metabolic and other dynamics.

I agree. However the current CMS “solution” to the “unreasonable high cost” of American medicine is “prevention”. Efforts towards prevention has created the search for finding and treating many preconditions such as”prehypertension”, “prediabetes” and lab values like cholesterol,
vita min D levels, bone density scores,PSA, CRP, benign colon polyps,
asymptomatic atherosclerosis, mild COPD, ect .This makes the suggestion noted in the video to test, diagnose and prescribe only significant conditions a dilemma for the physicians who must comply with CMS preventive care algorithms to receive payment for services.

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