Saturday 15 April 2017

Treating the numbers, not the patient

This story is a good example that goes along with a previous post about treating (and correcting) surrogate factors (like X-rays and blood tests) instead of treating patient health (see: The map is not the territory). In this case, hypothyroidism (low thyroid hormone levels) in older people comes under the spotlight. If patient don’t have any symptoms, it is still often treated in order to correct the ‘disease’ state. But as researchers found in this randomised trial, replacing their thyroid hormone (compared to placebo) definitely improved the thyroid hormone levels in the blood, but it did nothing to any other outcome measured. It didn’t help the people being treated.

This is a classic example of overdiagnosis – discovering an abnormality in some people (a low thyroid hormone level is common in older people) and labeling it a disease. Doing so then leads to overtreatment aimed at addressing the ‘abnormality’ rather than aimed at improving the health of the patient. This last part is the trick of overtreatment – correcting things in our body is surely good for us, right?  No, not always. It needs to be shown that it is – not assumed. And any benefit shown needs to outweigh any unintended consequences and direct harms from the treatment.

The other problem I have with the problem of overdiagnosis and overtreatment is that the research that shows them wrong comes so many years after the practice has become entrenched (like in this case), making it much harder to undo common practice than if the research was done before the treatment was introduced.

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