The Preposterous Epidemic of Pre-Diseases

By Brian Fung
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If you're on the verge of developing diabetes, you're "pre-diabetic." You've got "pre-hypertension" if you're about to be diagnosed with high blood pressure, "pre-anxiety" before getting anxiety, and and "pre-dementia" before dementia. As if actual diseases weren't frightening enough, we now have what seems like a whole encyclopedia of pre-diseases to fear. What's with our fixation on inventing new diagnoses by fragmenting old ones, and what kinds of costs does it impose on society?

Preconditions don't always lead to actual conditions, but that doesn't stop millions of Americans from seeking treatment of some kind anyway. In fact, over 100,000 people die every year due to complications associated with medical treatments, according to Ivan Oransky, the executive editor of Reuters Health, who spoke yesterday at TEDMED, a three-day conference in Washington, D.C. on technology and medicine.

As with many of the challenges facing the country's healthcare system, the profit motive has a large role to play in exacerbating the prediagnosis epidemic. Making treatments available for preconditions does more than enable more frequent diagnoses of said illnesses, Oransky believes. It actually creates greater demand in a weird kind of feedback loop, because people want to believe that every medical ailment has a ready medical solution.

"You can actually, perversely, tell people to come" and be diagnosed with preconditions, Oransky told TEDMED attendees. "You can convince them that they have to come."

"I have another name for these preconditions," Oransky added. "I call them preposterous."

In many cases, he said, over-medicalization may be counterproductive. Instead of developing better lifestyle habits, patients go to doctors seeking drugs, which are provided by pharmaceutical companies aiming to sell as many pills as possible. Meanwhile, precondition advocacy groups whose survival depends on successful fundraising have an interest in perpetuating the idea that preconditions are themselves diseases that must be treated medically.

It's hard to know whether better living can eliminate all preconditions. But the culture of precondition diagnosis may be doing more harm than good.

"I have really bad news for all of you," Oransky said. "You all have a universally fatal condition. It's called pre-death. Every single one of you has it, because you have the risk factor for it, which is being alive."

This article available online at:

http://www.theatlantic.com/health/archive/2012/04/the-preposterous-epidemic-of-pre-diseases/255800/