Treating the numbers, not the patient

What’s your blood count? Blood pressure? Bone density? PSA? If it is abnormal, odds are that you will want it to be normal. In doing so, you are making the same leap of faith that your doctor is making when he commences treatment: that treating the numbers will improve your health. Like much of what we do, treating the numbers is often naïve, and sometimes harmful, no matter how well intentioned. Read these short examples and tell me if you still want your numbers normalised.

Book review: Overtreated

Title: Overtreated: why too much medicine is making us sicker and poorer (2009)

Author: Shannon Brownlee

Publisher: Bloomsbury

There appears to be many books on the topic of overtreatment, overdiagnosis, medicalization, medical error and what’s wrong with modern medicine in general. This book covers all of those topics, but focuses on the simple theme that more medicine does not lead to better health. Instead, it leads to higher costs and worse health.

The Uncertainty Principle: from Heisenberg to Hawthorne

I know that Heisenberg’s Uncertainty Principle refers specifically to physics (in that you cannot simultaneously measure the momentum and position of an electron),¹ and I know that its interpretation has been generalised to the point where some take it to mean that nothing is certain, but at the crux of the Uncertainty Principle is the concept that you change things by measuring them. Specifically, that you will change the very thing that you are trying to measure, simply by measuring it, and you have to admit, that’s pretty cool. The Uncertainty Principle can be fun in popular culture² but in medical research, it causes problems.

Deciding versus consenting

The consent process in medicine is serious stuff. Consent forms are fine-tuned every few years to get them just right, and often a negligence suit can hang on the consent form and consent process. Less emphasis is placed on the decision process that led to the patient signing a consent form in the first place. It turns out that the more information a patient receives, the less likely they are to ‘sign up’ for the procedure.

Book review: Stabbed in the Back

Title: Stabbed in the Back. Confronting Back Pain in an Overtreated Society (2009)

Author: Nortin M Hadler

Publisher: University of North Carolina Press

Nortin Hadler has written widely on the problems with modern medicine (overtreatment, overdiagnosis, medicalization) but he is also someone who is doing something about it, and his ideas on healthcare reform are novel, well informed, feasible and reasonable. For these though, you should read Worried Sick: A Prescription for Health in an Overtreated America. This book covers back pain; from historical, cultural, physical, social, occupational and psychological perspectives.

Health – it’s all relative

Why does Japan have the highest life expectancy and one of the best health systems, yet less than 50% of the population consider their health to be good or very good (one of the lowest scores in OECD countries)? What is health; is it the absence of a negative (disease, pain) or is it a positive concept?

Health can be measured and quantified objectively (with things like life expectancy, body mass index and blood sugar levels) or subjectively, by asking people how healthy they think they are. Objective measures provide hard data that can be useful, but they do not tell us much about how the patient perceives their own health. For this we use terms like Health-Related Quality of Life, a concept closer to things like life-satisfaction, happiness and subjective well being. It is argued that this (subjective measure) is the most important measure of health.

It turns out that self-rated health is surprisingly constant over time (despite changes in objective health), because reporting of health is relative.