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This article and the related one in the BMJ (over-diagnosis and the harm to patients) by Suzanne O'Sullivan (31st May, page 242) make little reference to the labels attached to us all by QOF, be it CKD, pre-diabetes, grade 1 heart failure, etc. These in turn, utilise a massive proportion of primary care time and resources with their regular blood tests and reviews. I suspect many people would rather be able to see their GP when they want or perceive they need to. I fully accept that these prodromal labels can in part, be modified, but having your holiday insurance inflated by a rise in Hba1c from 41 to 42, your 10 yr CVD risk going from 9.9 to 10.1%, etc, may have more serious consequences than just labels.
Toon asks ‘What is Illness?’, and repeatedly refers to ‘grey’ areas, (my italics), whether physical or psychological, and describes how determinants may be economic ‘disease mongering’, (his italics), social, or political.1 The idea that a religious experience in one culture is an illness in another is not new. He does not consider the societal, economic, or individual costs of the ever-expanding reach of definitions of illness, (and attendant incapacity), or of attempts to remedy these conditions. His question is driven by the providers of intervention, rather than recipients. A valid balancing question might be ‘What is Health?’: how many of us ask this in the context of our National HEALTH Service? I would observe that most people regard themselves as healthy if they don’t take prescribed medications: the more they take, the less healthy they perceive themselves to be. Starting medication, even in the cause of risk reduction rather than obvious disease management, is likely to change the recipient’s perception of being healthy to being unhealthy, and more so if they experience adverse effects of well-intended prescribing. The consequent psychological change of self-image is in general difficult to judge, but for some individuals can be profound and detrimental. Healthy people often purchase discretionary healthcare; whether medicinal, physical or psychological. Stoicism is out of fa...
Toon asks ‘What is Illness?’, and repeatedly refers to ‘grey’ areas, (my italics), whether physical or psychological, and describes how determinants may be economic ‘disease mongering’, (his italics), social, or political.1 The idea that a religious experience in one culture is an illness in another is not new. He does not consider the societal, economic, or individual costs of the ever-expanding reach of definitions of illness, (and attendant incapacity), or of attempts to remedy these conditions. His question is driven by the providers of intervention, rather than recipients. A valid balancing question might be ‘What is Health?’: how many of us ask this in the context of our National HEALTH Service? I would observe that most people regard themselves as healthy if they don’t take prescribed medications: the more they take, the less healthy they perceive themselves to be. Starting medication, even in the cause of risk reduction rather than obvious disease management, is likely to change the recipient’s perception of being healthy to being unhealthy, and more so if they experience adverse effects of well-intended prescribing. The consequent psychological change of self-image is in general difficult to judge, but for some individuals can be profound and detrimental. Healthy people often purchase discretionary healthcare; whether medicinal, physical or psychological. Stoicism is out of fashion, (and sometimes delays serious diagnosis), but when wants become needs, individuals suffer unrealised expectations and NHS health expenditure extends to the unsustainable. The secondary gains which Toon describes, subsequent to the receipt of some illness labels often serve people no benefit, and prolong incapacity at great cost to individuals and society. 2-3 Perhaps an understanding of the term health, as perceived by individuals, might help inform the limits of medical intervention, without which medical expenditure will continue to expand, ultimately bankrupting the country.
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British Journal of General Practice
