In the news recently was someone or other’s recommendation that less severe degrees of obesity than morbid obesity be also treated by gastric bypass. This should surprise no one. There are constantly “discoveries” that it is better to be more and more aggressive with blood pressure, cholesterol, blood sugar targets; etc.; and thresholds for treatment are generally lowered with each new series of recommendations.
Diagnostic and treatment thresholds ratchet ever downward. It’s definitely good business. But is it good medicine?
As treatment thresholds move downward, medical expenses move upward. And something else occurs: as thresholds are lowered for treating various risk factors, the benefit/risk ratio changes markedly.
Iona Heath notes this in a recent PLOS article in an April PLOS collection of articles on disease-mongering: "We are witnessing diagnostic drift in a whole range of conditions, from depression to hypertension, with pressure for more and more people to be included within the range of abnormal and offered treatment. The justification for these treatments is often based on short-term studies, which are then extrapolated over much longer time periods. There is insufficient recognition of the fact that the less the need for treatment, the higher the number needed to treat for given outcomes and the higher the risk to patients, since the rate of adverse effects remains constant."
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