Thinking About Disease
This post is about disease – not something we generally like to think about unless and until we’re diagnosed with one or another disease or precursor to disease.
But there’s real value in thinking about the disease process that occurs in all of us before we’re hit with a diagnosis that may send us into a tailspin of ill-advised medical interventions that themselves may pose more of a threat than the feared disease (see “America’s Health Scare System” for more on this).
Better understanding your true disease risk – both in the abstract and in very personal terms – empowers you to request screenings, lab tests, and other risk assessment tools appropriate to your actual risk profile. It also enables you to reject those that are inappropriate to your risk profile.
This is important because too much of contemporary healthcare applies a “herd” mentality in which everyone over a certain age gets screened for things they often don’t need. This generates tests and procedures that can cause harm and medical bills that patients are increasingly responsible for paying themselves.
While it’s true that Obamacare makes some screening tests free for many Americans, this may prove a double-edged sword if it leads to more avoidable follow-up tests and other medical interventions that weren’t needed in the first place (what’s called “overtreatment” in medical jargon). This is already a major contributor to the estimated third-to-half of medical care in America that’s considered to be unnecessary.
By learning more about your disease risks and the risks and benefits of screening for them, you’ll be in a better position to be proactive in seeking what you really need and rejecting what you don’t.
While you’ll always need medical advice and guidance, this learning is central to the kind of empowered patient you’ll need to become to survive the patient safety crisis in America (see “Patient Safety or Endangerment?” for more).
This crisis promises to grow even worse as patient demand increases as Obamacare is implemented while the supply of physicians to meet that demand remains woefully inadequate. And Washington’s failure to prepare for this medical manpower shortfall borders on political malpractice (see this article in The New York Times for more on this).
Disease & Diagnosis
It’s important to understand the difference between disease risk and diagnosis. It applies equally to both your dealings with the medical system and your efforts to avoid it with better lifestyle choices.
While this distinction will seem obvious to many readers, it’s routinely confused in our medical decisions and is an area ripe with potential for improved decision-making.
Most of us assume if we haven’t been diagnosed with a disease that we’re “healthy”. There’s ample evidence, however, that most diseases fester in our bodies for years, even decades, before manifesting themselves with symptoms or by progressing sufficiently to be detected by lab tests or medical imaging.
A healthy human body is a scientific marvel in its native ability to defend and repair itself. But this innate capacity diminishes with age and/or disease, setting the stage for disease to take control and overpower your body’s diminished self-protective mechanisms.
Youthful hormonal production – estrogen in women and testosterone in men, for example – that protects us during our reproductive years diminishes with age.
The same, of course, can be said for most bodily functions, as reflected in (among other things)…
Reduced digestive ability to absorb essential nutrients;
Diminished ability of the liver & kidneys to metabolize and remove dangerous toxins, including medications;
The resulting build-up of toxins in the bloodstream; and
Reduced circulation of oxygen-rich blood & nutrients to nourish the heart and brain
All of this adds up to the increased risk for disease seen among older adults. But age is only one of several factors contributing to your disease risk.
What About Genetics?
Whatever disease risks you may have inherited – your unique genetic predispositions for disease based on your family history – don’t necessarily dictate whether and what diseases you’ll incur.
Instead, these represent vulnerabilities to disease that may or may not be triggered by your lifestyle or treatment choices. Most of us die with most genetic vulnerabilities still dormant and with multiple disease processes occurring in our bodies that were not directly responsible for our demise.
In other words, disease is not a “black-or-white” proposition.
We can have disease and not realize it and we can also be misdiagnosed with a disease that we don’t actually have.
There are, for example, an estimated 7 million or more Americans with type 2 diabetes that have yet to be diagnosed even though they have diabetes. Are these people healthy because they think they have no diagnosable disease?
Of course not, they just think they’re healthy, but are unaware of their true condition.
According to the National Institute of Health, there are an additional 79 million Americans with suspected “pre-diabetes” – three times the number of current diabetics – and they, too, are mostly blissfully unaware of their heightened disease risk.
This is not unique to diabetes – “pre-disease” states apply to virtually all diseases. This reflects the fact that the disease process is generally a continuum that starts with disease vulnerabilities like genetic predispositions/family history.
These are then aggravated, or stimulated, by various lifestyle, environmental, and other factors that may trigger full-fledged disease states unless remedial measures are instituted to avoid this result.
Know Your Disease Risk Profile
It’s critically important, therefore, to know your disease status and risk profile if you expect to adopt a meaningful approach to avoiding disease complications and protecting your health, as well as assuring you don’t incur unnecessary tests and procedures and their associated expense.
While many people rely on their primary care physicians for such purposes, fully one-third of Americans report not having one.
Those who do are subject to the same human error and other physician foibles reviewed in Our Healthcare Sucks – meaning they may well be receiving sub-optimal care.
And it’s highly likely they’re receiving unnecessary care, since an estimated ⅓ – ½ of medical spending in the U.S. is unnecessary – driven often by physicians’ priority of protection from a lawsuit you might file against them if they don’t order a test or procedure and you’re subsequently diagnosed with disease.
Accepting Life’s Uncertainties
The point here is if you look hard enough you will find disease of one kind or another because we all harbor multiple forms of disease at varying stages of development and danger (see “Medical Uncertainty & Patient Engagement“).
Some are non-threatening and are best ignored – the risks of causing disease by “treating” the suspected condition may outweigh the probable benefit.
This is a hard concept for most of us to accept – which is why we need better understanding of our true risk for disease to reduce our risk of treatment injury we might avoid.
If you harbor any doubts about the reality of harm caused by medical treatments – including premature deaths that exceed those from any cancer – read Our Healthcare Sucks, where the evidence to support this claim is explored in detail.
This post assumes that very real threat is understood and is a driving factor in your need to get a better handle on your actual risk for disease.
Without this knowledge, you remain vulnerable to victimization by our profit-obsessed medical system.
Knowledge is power – in this case the power to defend yourself and your family from the prevailing medical practices that put you and them at risk to protect doctors and hospitals from malpractice risk and to fatten their coffers with unnecessary tests and procedures.
And if you doubt this, consider that the medical profession itself has finally gotten around to identifying over a hundred “dubious” medical practices. Ever wonder how they got to be mainstream medical practices in the first place?
And do you suppose this is what Hippocrates, the father of modern medicine, had in mind when he cautioned physicians to “Do no harm”?
 National Diabetes Statistics, 2011. National Diabetes Information Clearinghouse, National Institute of Health.