Healthy? Think Again
New ways of diagnosing illness are changing the rules of medicine. How to sort out what it all means:
One fall day in 2003, more than 20 million Americans went to bed healthy and woke up sick. They didn't feel any different--no 24-hour stomach virus, no late-fall cold. What happened? An international committee published new guidelines for declaring someone "prediabetic" --that is, at increased risk of developing diabetes. Overnight, people who had never considered themselves sick were being told by their doctors that they had a medical problem. "Here are people who have been mostly doing what I asked--they've been keeping their weight under control, exercising, and keeping their blood sugar levels constant, which is a good thing," says Jenni Levy, a primary-care physician in Bethlehem, Pa. "But now I had to say that this is now abnormal. You have not changed, your blood sugar hasn't changed, but the rules have changed."
The rules are changing everywhere. The threshold for prehypertension--worrisome blood pressure--has been lowered. So has the level of cholesterol that should be treated with statin drugs. Today, doctors routinely diagnose--and treat--a condition called osteopenia, a precursor to osteoporosis. Oncologists now treat cancer, often aggressively, at such early stages that it isn't even cancer, just an abnormal state that may--or may not--progress to the disease. Throw in conditions like mild asthma, which until just weeks ago was commonly treated by a daily dose of steroids, and being sick suddenly begins to look like the new normalcy. Consider: The new definition of prediabetes alone means that 40 percent of adults between the ages of 40 and 74 now have the condition, while the definition of prehypertension slapped that label on 45 million Americans. "We are looking harder," says Gilbert Welch, a faculty member at Dartmouth Medical School who wrote Should I Be Tested for Cancer? and who codirects the VA Outcomes Group. "We're redefining disease, we're using existing technology more frequently, and we're using more advanced technology than in the past. All have the same result: There's more disease out there."
This is, odd as it may seem, progress. After all, the earlier that signs of trouble are identified, the better--like fixing the knock in your car engine before it seizes up on the highway. But as the definition of illness encompasses more people, doctors and researchers are questioning whether this is always a good thing. Life expectancy for Americans rose to a record high of nearly 78 in 2003, so how can so many of us be sick? And what should you do if you're one of them?
Stuff under the sink. In some cases, discovering a disease before it becomes a full-blown medical emergency allows a patient and his physicians to nip it in the bud. As recently as the 1950s, cervical cancer killed more women than breast cancer. Then came the Pap smear, which lets doctors catch abnormal cells before they morph into invasive cancer. That has meant a drastic cut in the death rate of the disease. Studies also show that early intervention can help hold off hypertension and diabetes. "I turn to [patients] and say, 'Your sugar is elevated, and if you do nothing about it, you may progress to diabetes,' " says James Dudl, a physician with Kaiser Permanente in San Diego. "'But if you would lose 7 percent of your body weight and exercise five days a week, there's a 58 percent chance of keeping diabetes away at least for a few years."
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