[Disease-mongering -- it's all the rage:]
May 21, 2006
If You've Got a Pulse, You're Sick
By GINA KOLATA
For a nation that spends more than any other on health, the United States certainly doesn't seem very healthy.
Many cancers are on the rise — prostate, breast, skin, thyroid. We're fatter than ever. As for diabetes, the number of people who say they have it has doubled in the last 10 years. Now a report says that the English — those smoking, candy-eating, fish-and-chips lovers — are actually healthier than Americans. And they spend half as much on health care.
The American-English comparison, published this month in The Journal of the American Medical Association, analyzed data from people's own reports of their health and also used some objective measures: a blood test for diabetes, using hemoglobin A1c, and blood tests for proteins associated with heart disease risk, fibrinogen and C-reactive.
Their blunt conclusion?
"Americans are much sicker than the English," wrote the investigators, led by Dr. Michael Marmot of University College Medical School in London.
People tried to find reasons. Maybe, many said, the problem is that Americans are under too much stress.
But, as often happens when it comes to statistics, what this all means may depend on who is doing the interpreting.
It's hard to make cross-cultural comparisons — the populations may not be representative. But it can be even worse when the question involves health. Sometimes, the data that are needed just can't be found because what one country measures, another guesses.
Take obesity, for example. Dr. Jeffrey M. Friedman, an obesity researcher at Rockefeller University, once wondered how much thinner Europeans actually were. So he looked for nationally representative data that included actual measures of weight, not just what some groups of people said they weighed. The United States has such data, but not Europe, with the exception of England.
"You can't get those data," Dr. Friedman said. "They don't exist."
There is, however, one statistic that scientists say is fairly solid: life expectancy at birth. And in comparing the figures for the United States and Britain, it turns out they are almost identical: 77.6 years in Britain; 77.1 in the United States.
"What do you mean by saying we're not healthy?" asks Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina. "How do you define health?"
The question of which country is healthier, Dr. Hadler and others say, turns out to be a perfect illustration of an issue that has plagued American medicine: the more health problems you look for, the more you find. And Americans, medical researchers say, are avid about looking.
The British, doctors say, are different.
"The U.K. has a tradition of independent and perhaps more skeptical primary-care practitioners who are probably slower to label and diagnose people and more reluctant to follow guidelines than their U.S. counterparts," says Dr. Iona Heath, a general practitioner in London. "I have heard it argued that the U.S. believes more in the perfectibility of humanity and the role of science than the Europeans."
Some people call it disease-mongering, says Dr. Lisa Schwartz of Dartmouth Medical School. She once calculated that if everyone had the recommended tests for blood cholesterol, blood sugar, body mass index and diabetes, 75 percent of adults in the United States would be labeled as diseased. And new diseases arise by the minute, she says, her favorite example being "restless legs."
... [T]he lesson for Americans is clear. These days, and especially in the United States, with its screening and testing, "we are labeled," said Dr. Hadler of North Carolina.
"I call that medicalized," he added. "And one of my creeds is that you don't medicalize people unless it is to their advantage. When you medicalize people, they think they're sick, and in our culture it's, 'Do something, Doc. Don't just stand there.' "
Dr. Hadler has written a book about the problems of medicalization, calling it "The Last Well Person: How to Stay Well Despite the Health Care System" (McGill-Queen's University Press, 2004). The title refers to a story told by Dr. Clifton K. Meador, director of the Meharry-Vanderbilt Alliance, a cooperative program between the medical schools in Nashville.
One day, as Dr. Meador tells it, a doctor-in-training was asked by his professor to define a well person. The resident thought for a moment. A well person, he said, is "someone who has not been completely worked up."
<http://www.nytimes.com/2006/05/21/weekinreview/21kolata.html>
Carl