Healthy? Think Again
New ways of diagnosing illness are changing the rules of medicine. How to sort out what it all means:
With many diseases influenced by lifestyle choices--diet, exercise, tobacco use--early warnings can be a vital wake-up call. "It may be the thing that is motivational enough to prompt both patient and physician action," says Paul Wallace, executive director of Kaiser's Care Management Institute. An "official" diagnosis also means patients can be reimbursed for visits to a dietitian or counselor. That's what happened when Beatrice Velasco of San Diego was told she was prediabetic--frightening, since her sister died of diabetes. Velasco quickly saw a dietitian, switched from Atkins to a more inclusive diet, and started walking 30 minutes a day. "The doctor said if I follow my diet and walk," says the 66-year-old, "I'll never have to go on insulin."
Early intervention is even more critical with young people and kids. A 75-year-old edging up on hypertension is very different from an 11-year-old whose body might be affected for decades. In the case of kids, anticipating early signs of diseases like hypertension is like "getting household cleaning stuff out from under the sink," says Bonita Falkner, a pediatrician at Thomas Jefferson University. And if diseases really can be prevented, particularly chronic ones, that could save lots of money.
Marathon man. As great as all this sounds, there are some hazards in defining illness as early as possible. Labeling someone as ill can cause anxiety and fear. "When you tell someone they have a disease," says Levy, the Bethlehem physician, "you are challenging something very fundamental about their self-image." That can cause real damage. One study found that some women told they had osteopenia were so frightened of fractures that they stopped exercising, though physical activity can retard bone loss. Sometimes, treating disease in its very early phases may not work. "We have a well-ingrained mind-set for so much of medicine--fixing what is broken," says Kaiser Care's Wallace. That mind-set is appropriate for the seriously ill, he says: "But there are situations where there isn't a quick fix."
Take osteopenia. The disease was arbitrarily defined as a statistical variation from the bone mass density of a woman in her 20s. Using that definition, half the women over age 52 have osteopenia, says John Abramson, author of Overdosed America and an instructor at Harvard Medical School. But bone density is only one of several factors that contribute to bone fractures, the ultimate concern. Steve Cummings, an epidemiologist at the University of California-San Francisco medical school, says there is no evidence that treating otherwise healthy women with osteopenia with osteoporosis drugs cuts the risk of hip, wrist, or rib fractures later in life.
Even if early treatment changes a specific clinical measurement, it may not result in improved longevity. Giving statin drugs to low-risk patients with normal cholesterol levels, for example, did cut the risk of heart attack, but it failed to reduce the death rate of those patients. A study found that treating prehypertension cut the risk of a stroke slightly, but the patients didn't live any longer. Just last week, another study showed that people who are now identified as "overweight" (though not obese) actually live longer than people of "normal" weight.
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