By Punya Srivastava
The malady of overdiagnosis is creating more diseases and trauma than actual ailments themselves, says Punya Srivastava
"For a man with a hammer in the hand and wanting to use it, everything here looks like a nail needing hammering." - Mark Twain
I felt the same about the neuro-specialist at a reputed private hospital who I had consulted a few months back for a constant headache that lasted over five days. I went to the specialist after acupressure failed to give me relief. I was made to undergo a CT scan quicker than I could say headache. Then, with the scan report in his hands and not more than five minutes spent on my supposed diagnosis, he labelled my headache as the side-effect of stress and onset of hypertension. I was prescribed three medicines twice a day for a week. Just after two doses, my blood pressure plummeted and I was plagued by constant dizziness and drowsiness. After a quick check on the net, I got to know that I was prescribed quite strong doses of blood pressure regulatory medicine, sedatives and anti-depressants! Terrified, I immediately threw them in the bin. The headaches got over with proper rest within the next two days. I was to later learn that the headache indicated the onset of cervical spondylosis, thanks to heredity and my sedentary job, and not hypertension, as the specialist would have me believe. More than anger, I felt appalled at the callousness with which the so-called specialist had handled my case. I was made to shell out around Rs 1500 for a useless CT scan (at half the price, thanks to my mother’s CGHS card, or else I would have been ripped off some more) and equally useless medicines which did more harm than good. Not to mention the energy and resources wasted in this unnecessary exercise.But then, after pondering over this experience, I realised that I too had contributed to this situation. I had given in to fearful thoughts of a brain tumour sprouting within, thanks to all the brouhaha about cancer these days, and rushed to a specialist. Had I restrained my thoughts and placed more faith in my body’s intelligence, I wouldn’t have had to undergo this harrowing experience.
Much ado about nothing
Overdiagnosis is a term gaining a lot of attention these days. According to various research studies published in the New England Journal of Medicine (NEJM), a wide range of ailments are being overdiagnosed across the world, some of which include breast cancer, ADHD, chronic kidney diseases, asthma, osteoporosis, hypertension, diabetes and high cholesterol.There are many ways in which overdiagnosis takes place. It usually happens when asymptomatic people are tested for ailments through routine health checkups. Since each person’s body operates on its own innate intelligence, a few apparent abnormalities or disorders are bound to be detected which might not fall within the normal health range. And yet, unmindful of this, modern medicine administers similar intervention to every such case. A complex body-mind-spirit entity is reduced to a machine that needs fixing.
Overdiagnosis can also aggravate symptoms which might have lain dormant, had they not been disturbed by unnecessary medical intervention. According to American academic, physician and cancer researcher Dr Gilbert Welch, from a sample study of 1.3 million women in the USA over the last 30 years, most women diagnosed with breast cancer via mammography never had cancer to begin with. These women underwent surgery, chemotherapy or radiation for a cancer that was never going to make them sick. The imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small preventable effect on the rate of deaths from breast cancer, reads the inference of the study.According to Dr Ravinder K Tuli, a Delhi-based allopath turned holistic medicine practitioner and founder of Society for Holistic Advancement of Medicine (SOHAM), mammography emits 30 per cent more radiation than a normal X-ray. This means many women are exposed to unnecessary and potential harm just because of the fear of breast cancer.A complex web of factors has created the phenomenon of overdiagnosis. The mainstream media promotes fear of disease and perpetuates the myth that early, aggressive treatment is the best remedy. Mainstream doctors too, in an attempt to avoid lawsuits, have begun to prescribe tests and scans to avoid taking responsibility. Mushrooming diagnostic centres and five-star private hospitals flaunt their state-of-the-art facilities and imported equipments by claiming superior quality of check-ups and treatments in order to make quick money.Another factor contributing towards overdiagnosis is the manipulation of diagnostic criteria for a plethora of conditions by pharmaceutical giants in order to keep themselves in business. The most commonly overdiagnosed conditions are hypertension and diabetes the harbingers of sickness in an otherwise healthy person once he or she starts with remedial treatments, says Dr Tuli.
Dr Aruna Vishwanathan, an Integrative Holistic Health expert based in Goa, shares the same opinion. She cites that cholesterol is the most commonly overdiagnosed condition across the globe and that the topmost pharma giant in the Fortune 500 list is the one manufacturing statin – a cholesterol lowering drug. She also points to the increasing cases of Vitamin D3 deficiencies coming to light. That is because Indians have melatonin that makes it difficult for them to absorb Vitamin D directly from sunlight. But these days just about every person is running to get his or her D3 test done, she adds.Also, technologically advanced and increasingly sensitive screening procedures are picking up less severe forms of disease or abnormalities that otherwise wouldn’t have posed any risk to the individual if left undisturbed. Moreover, since a human being’s anatomy is a closed and complex system, these interventions often hamper the body’s innate capacity to heal itself through a strong immunity. The potential harms of routine annual screenings exceed their potential benefits.In fact, a study in the UK conducted a few years back on routine health checkups inferred that such checkups, when done on normally healthy people, pronounce the beginning of their end. For example, when a healthy person is administered statin for a long duration, his muscles start getting destroyed, says Dr Vishwanathan. She also recounts the case of a healthy 45-year-old man whose colon was removed when detected with a benign polyp, simply because his father had died of colon cancer.Ironically, being at risk of a potential ailment is being treated as an ailment in itself by a health care system dominated by modern medicine that is overdiagnosing and overtreating people.
Addressing fear and panic
Padmabhushan Dr B M Hegde, renowned medical scientist, educationist and author, while talking at the Congress on the Rise of Complementary and Alternative Medicines (CAM) and its Movement towards Integration, organised by Life Positive Foundation in March this year, mentioned that a senior dignitary of the Government of India had consulted him a few years back because a famous cardiologist had recommended an urgent angioplasty or bypass surgery.Upon studying his reports Dr Hegde discovered that the said anomaly had existed even in his ECG report taken some 35 years ago. He told the gentleman that he must have been born with this condition, and if he could have survived for 35 years without any difficulty, he could go on for another 35 years too, since the problem was lying dormant. The gentleman is leading a normal life without going through angioplasty or bypass, just by maintaining a healthy lifestyle, Dr Hegde remarked. According to him, if we can put an end to coronary angiogram meant for the diagnosis of anginal pain, millions of lives can be saved from morbidity, adverse drug reactions, and premature death.According to Dr Tuli, people too are guilty of contributing to this malaise. Most of us don’t know how to take care of our health, and even if we do know, we do nothing about it. Popular media too adds to the confusion by propagating myths and hype without verifying facts, he says. He illustrates this by pointing to the recent cases of dengue and chikungunya, where fear and panic exaggerated the situation to the point of creating a furore. All that a person suffering from dengue or chikungunya has to do is to bring the fever down by taking ample rest, and eating light and nourishing meals. Instead, everyone rushes to get a blood test done which, without serving any purpose, over burdens an already stressed administration, says Dr Tuli.
As Dr Hegde says, In any epidemic (pandemic), overdiagnosis is the rule and not exception. So many times epidemiologists produce epidemics. Epidemiology is an inexact science. Media should not make a mountain out of a mole hill based on this inexact science.Dr Vishwanathan laments that sometimes physicians are obliged to write prescriptions because people come to them with their tests reports hoping to seek solutions for problems that do not exist. However, the doctors too need to stop labeling people according to their reports. Instead of focusing on the disease, I focus on healing, maintaining that the person is only going through an imbalance in the body, she says. She recalls, Once a person from Holland approached me because his doctors back home had asked him to get a diagnosis done for Alzheimer, even though the diagnosis would not lead to a cure. My only question to him was, Do you need a diagnosis or a cure? Within two and a half weeks of taking ayurvedic medicines, his memory improved drastically. I call this dissolving the diagnosis.
Right step forward
The only solution to the malaise of overdiagnosis is to put an end to our habit of fault finding. Let’s shift our consciousness from what is wrong in my body to what is right in my body. The knee-jerk reaction of rushing to find a cure has only plummetted us from the frying pan into the fire. Treating the physical body with all the respect that is due to it, and owning the responsibility for our health instead of passing it on to the experts are necessary steps in this direction.Dr Tuli emphasises the need to embrace yoga as a way of life to improve the quality of life. Guiding my patients on lifestyle management has helped them embrace a healthy life, freeing them from apparent chronic conditions like diabetes and hypertension, he says.
Thus, instead of relying on annual screenings and routine health checkups, let us start becoming intuitive about our own bodies. This doesn’t mean that all the screenings or checkups are redundant, but it is indeed time to apply greater discernment over what warrants investigation and intervention, and what clearly does not. Instead of running to the doctor, start running for your health, says Dr Vishwanathan, stressing the importance of exercise, diet, and emotional-mental well-being in building the body's high defenses. She also insists that people pay heed to their common sense instead of running to doctors at the slightest discomfort and depending on them for their well-being.Let us start with mindful awareness of the signals our bodies send out in the forms of fevers, aches, and inflammations. Instead of popping pills to suppress these symptoms, let’s give them the attention they demand and reach out to natural and holistic avenues to heal any disorder. As Dr Hegde says, People with depressed immune systems are the ones who fall sick, and building a strong immunity is the best preventive measure against sickness.
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