We all have a fatal condition: it's pre-death


MEDICAL MATTERS:Diagnosis of ‘pre-diseases’ is a growing trend

FEELING A bit left out because you are disease-free? Perhaps coffee mornings or lunches are somewhat one-sided as you listen to the health adventures of friends or colleagues?

There is a growing trend to diagnose people with “pre-diseases”. If you are about to develop diabetes, then you are “pre-diabetic”. And if you’re on the verge of being told you have high blood pressure, then you have “pre-hypertension”.

When you Google pre-disease, one of the first references to pop up is a website called predisease.com. This is its opening blurb: “Pre-disease is early disease. Disease has already begun and the complications and co-morbidities have started in the body. This is the stage when the body’s optimum balance or homeostasis is being disturbed. For example, in pre-diabetes, damage to kidneys, eyes, heart and nervous system have already begun and will progressively worsen, if not treated. When your cholesterol levels are slightly elevated, inflammation and damage to the coronary arteries has started with accumulation of plaque and this progressively worsens, if not treated.”

Scroll on and you will find how to order pre-emptive meds, special “pre-disease” therapies “to arrest the progression before it becomes irreversible”.

Dr Ivan Oransky, executive editor of Reuters Health, told the recent TedMed conference in Washington DC that preconditions don’t always lead to actual medical conditions; but that does not stop millions of people seeking treatment.

“You can actually, perversely, tell people to come” and be diagnosed with preconditions, Oransky told the conference. “You can convince them that they have to come.”

He reckons the profit motive plays a large part in exacerbating the prediagnosis epidemic. By making treatments available, we create a kind of feedback loop linked to a modern belief that every medical ailment has a medical solution.

But this culture may be doing more harm than good by prompting a rush to lifestyle drugs, which themselves have a raft of side effects. Oransky has another name for preconditions. “I call them preposterous”, he says.

Eminent psychiatrist Dr Thomas Szasz has published a collection of essays in which he outlines how medical diagnostic labels are now applied to everyday occurrences.

A freckle becomes the dermatologist’s friend. The tension headache prompts a CT scan and an expensive work-up. A skipped heartbeat must be assessed by a cardiologist and his box of investigative tricks.

This medicalisation of the western world is a major driver of health costs. With greater diagnostic abilities comes a treatment imperative. The screening industry may need to look at itself in this regard.

Screening often leads to finding conditions that are not at the stage or level that would classify them as disease but, at the same time, are not at a stage or level at which people can be declared entirely disease free. These inbetween states are easily transformed into “pre-diseases”.

Dr Anthony Viera of the Department of Family Medicine at the University of North Carolina has proposed that pre-disease discovered through screening should only be acted on if the following conditions are met: the people designated as having pre-disease must be far more likely to develop disease than those not so designated; there must be a feasible intervention that, when targeted on people with pre-disease, effectively reduces the likelihood of developing disease; and the benefits of intervening on pre-disease must outweigh the harms in the population.

Precondition advocacy groups may have a financial interest in perpetuating the idea that preconditions are themselves diseases that must be treated medically. It may be time to develop a health lobby to counter the sickness advocacy we see developing around us.

At TedMed, Oransky got it in one when he said: “I have really bad news. 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.”