Healthy? Think Again
New ways of diagnosing illness are changing the rules of medicine. How to sort out what it all means:
So what happens now? Researchers are trying to figure out who might benefit from early diagnoses and who might not. Says Bernard Levin, vice president for cancer prevention at Houston's M. D. Anderson Cancer Center: "The issue is not so much whether identifying precancer is a bad thing but how to individualize the treatment."
Until then, patients and doctors are going to have to get used to more complicated conversations about risks and benefits. One example: the prostate-specific antigen test. Despite its unproven accuracy, the PSA test is widely used to screen for prostate cancer. More recently, however, more doctors are debating when its use is and isn't appropriate.
With life possibly hanging in the balance, none of this, of course, is easy. But given the number of people now diagnosed as "sick" because of preconditions and the enormous costs associated with their treatment, many physicians say they can't afford not to ask the hard questions. The rewards of early detection of disease have long been clear. For now, however, we are only beginning to come to grips with the risks and the costs.
The New Rules
Over the years, the definitions of various diseases have been expanded. The new definitions encompass millions of Americans.
No. of additional
Condition Old threshold New threshold Americans affected
Prehypertension None Blood pressure
of 120/80 45 million
Prediabetes Fasting glucose Fasting glucose
of 110 of 100 21 million
High cholesterol 240 200* 42 million
Overweight BMI** of 25 BMI of 27 29 million
*Recommended by one study; government uses different criteria.
**Body mass index.
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