brianlynchmd.com

[drlynch]

This was first posted on another list in resposnse to what I thought was a terrrible article in the New York Times about over diagnosing in medicine.
There may be such a problem but the way it was explained left muc to be desired:





To all:

I was first tempted to respond to the Over-Diagnosing article but decided not to but feel obliged to now in light of xxxxxx's post.

I was frankly surprised by the "lightness" of the Times article, but then again lately I have been. I think as it having been written by an M.D. the writer is way too caviler with people's suffering.

To start with my conclusion: Medicine is, more or less, simply reacting to what society presents to it. From very early on I used to conclude from my exposure in a rural community through the eyes of a nursing family that Doc's should be at the forefront of prevention and public health. Of course they are and aren't. Prevention and Public Health are sub specialties and part of public policy and the public will as much as medicine.

Why are we sick. We are sick as well as I can tell being educated first as a Family Doc and now much more a therapist but interestingly very much seeming over time the same thing: we are sick because we are not interested in each other and we do not care for each other on a day to day basis. We have come to expect to pay our way out of anything.It is a lot easier than the grunt work of caring. That is one thing.

Two, never have so many people lived so long. Simple fact. You break down.

Three, good, well intentioned people devote their lives to wanting to alleviate pain so they try and find ways to do it. Any reader here wants discomfort alleviated and will be on the phone to do so. So "cast the first stone."

As for the article I thought, in the main, it was ridiculous particularly for its examples:

Quote: "How can this be? One reason is that we devote more resources to medical care than any other country. Some of this investment is productive, curing disease and alleviating suffering."
Brian: Good start

Quote: "But it also leads to more diagnoses, a trend that has become an epidemic."

Brian: Hyperbole, "epidemic?" Let's examine it?

Quote: This epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life. Increasingly, however, such sensations are considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.

Brian:

The question of what is "normal" has always intrigued me but leaving that aside more to the moment, it is complex.

I say most of it is a product of our overall society and you can't dump it on medicine. We are mostly affectively deprived and are killing ourselves with our technology which we all know. We eat badly and don't take care of our bodies and again do not relate well within much of a community.

With or without those facts:

Insomnia

"twitchy legs" or Restless Legs Syndrome" and sexual problems are real problems.

To be sure these problems are problems in various degrees, but I assure you in any of the cases if you have them they are no laughing matter and I wonder about laughing at anyone's discomfort.

It is hoped that we advance. Lloyd has helped us advance greatly by realizing the nightmare of what childhood has been so it won't be in the future. So just because we where not aware of RLS does not mean it did not exist. One, probably because, again not enough people lived this long. Two, people laughed at it and three, we could do nothing about it. Well, now we do have a treatment so more attention is paid to it. Believe me it can be quite debilitating and you don't want to sleep with someone that has a bad case of it. What is wrong with the commercial and many commercials is that they are "too nice". They in no way show the reality of the problem.

Insomnia: not a problem. That is laughable. I am sure more than a number of list members are hurt by that one. Much has been said about it. Many people seem to do ok with insomnia. But in general you should be sleeping throughout the night at least 6 or 7 hours. And if you have been and then start having trouble, yes usually it will pass, but if it doesn't it can and is debilitating and you need help.

Sex Drive: Where does he come off saying that impaired sex drive is a normal occurrence? What is he defining as normal? There is that word again "normal". Point is he is being very flippant and vague. My point, this coming from an M.D. to the public can be devastating, humiliating and shaming. One should never belittle such problems.If someone perceives they have a problem they have a problem, period. I would not go to this guy. He would probably say. Oh, buck up, don't worry about it, be a man!

Depression: His discounting "depression" speaks for itself. I have felt "depression" is so much more complex that I don't even use the term but that is another story.

As for Children:

Quote: Perhaps most worrisome is the medicalization of childhood. If children cough after exercising, they have asthma; if they have trouble reading, they are dyslexic; if they are unhappy, they are depressed; and if they alternate between unhappiness and liveliness, they have bipolar disorder. While these diagnoses may benefit the few with severe symptoms, one has to wonder about the effect on the many whose symptoms are mild, intermittent or transient.

Brian: I am sure Pediatricians around the country where up in arms. How this qualifies for "news that is fit to print" is beyond me. Cough after exercising is a harbinger of asthma. I have asthma, asthma is no fun. I look back at the '60 before the drugs we have now and know I might well have died several times. Asthma is mysterious in many ways. That only says it is mysterious and we have much to learn it in no way says it should be made light of. It is a killer.

I am all for giving much less or no medication in the psychiatric realm but that does not mean that children are not troubled or much better said, again, that communities and families are troubled. So often "everything" needs fixing not the child, as we know.

Quote:The other source is the drive to find disease early. While diagnoses used to be reserved for serious illness, we now diagnose illness in people who have no symptoms at all, those with so-called predisease or those “at risk.”

Brian: One can certainly be cynical and see this as a push to sell medication but in the interim, until we live better the data is there in a number of cases. And again this number of people simply have not lived this long. The world changes, we have never had this many people living this long and we have never had this technology and we have never had these medications. These are all independent facts. The motivations behind their use is a completely separate issue. We should not throw the baby out with the bath water. Use what is sensible and leave the rest. If you are at high risk for diabetes given the society we live in it might make a great deal of sense to start on metformin. You be the judge do YOU want diabetes. Laugh if you want.

Best to all.

Brain