Two recent reports, one American, the other prepared by University of British Columbia researchers, raise the same concern 鈥� over-doctoring.
The U.S. report, released by the American Cancer Society, proposes a dramatic increase in screening for colorectal cancer. The recommended starting age for colon-oscopy tests is 50. The society advises reducing it to 45.
That鈥檚 not in itself a huge change, though in sa国际传媒 each test costs the health-care system between $800 and $1,000, and more if follow-up procedures are required. As well, since the test involves inserting a flexible tube into the lower intestine, there is a risk of perforation, though the likelihood is small.
However, the society is also recommending that anyone aged 30 and over get a stool test every year to look for signs of fecal blood. This is problematic in several respects.
First, according to the Canadian Cancer Society, the risk of an adult aged 30 to 39 developing colorectal cancer over the next 10 years is 0.1 per cent.
Now, these are eight-year-old figures, while the American study used more up-to-date numbers. But double the incidence rate, indeed quadruple it, and the risk remains tiny.
Then again, subjecting adults aged 30 to an annual test when the evidence appears so slim is no small matter. Certainly, it will introduce an element of anxiety out of all proportion to the actual risk. It will also necessitate annual visits to a doctor and follow-up consultations. That would be enormously burdensome, particularly when there is already a scarcity of family doctors.
More important, this new policy, if adopted, is guaranteed to produce large numbers of false positives. These will necessitate a cascade of additional diagnostic procedures and further patient anxiety.
Physicians use the term 鈥渃ardiac cripple鈥� to refer to individuals who have an innocent symptom that is misdiagnosed as heart disease and cripples them with anxiety.
We are in danger here of creating colon cripples. This bears all the hallmarks of over-doctoring.
The UBC study, if anything, is more alarming. It found that the use of medication to control attention-deficit hyperactivity disorder in elementary-school kids has nearly doubled since 2000.
Yet there is no evidence that children aged six to 11 are more depressed or hyperactive than in years gone by.
What the researchers did find is that boys born between September and December were 41 per cent more likely to be given behaviour-modifying drugs. Girls born in these months were 77 per cent more likely to be medicated.
The reason seems clear. These are the youngest children in their class. As the authors say: 鈥淭his strongly suggests that teachers, parents and physicians are medicalizing a social rather than a medical problem.鈥� In other words, younger children are more likely to misbehave than their older classmates, and this is taken to justify the use of drugs.
But the downsides are significant. The medications in question decrease height and weight. They do not improve academic achievement.
More problematic, there have been no studies of the downstream effect on future health, incidence of drug addiction, employment prospects or longevity.
In practice, while these medications might help some kids, their purpose is also to make life easier for parents and teachers. They are, in this respect, the equivalent of chemical handcuffs.
True, sa国际传媒 is no exception. The same trend has been noted worldwide.
And the concern of family members who have to deal with hyperactive kids is understandable. Medication provides a simple and immediate way to intervene.
But other forms of therapy are available for treating ADHD, and while they are more time-consuming, they pose none of the risks associated with drugs. This is where parents should be steered, at least as a first option.
Both of these studies point in the same direction. As medical science offers ever more tools for diagnosis and treatment, physicians will be under increasing pressure to employ them. To the extent this improves well-being and longevity for patients, that is to be welcomed.
But at the same time, there is the potential for a far-reaching medicalization of our lifestyle. That is something to be concerned about.
A life lived under constant medical scrutiny might be a life reduced in quality.
