Bad medicine: modern medicineBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2346 (Published 28 March 2012) Cite this as: BMJ 2012;344:e2346
- Des Spence, general practitioner, Glasgow
More medicine should never be conflated with better medicine, because today developed countries are suffering a contagion of iatrogenic harm. Why has this happened? Profit is the poison at the heart of the problem, spawning health anxiety and unnecessary intervention. This phenomenon is taking grip in emerging economies, like those of China and India, with the new middle classes subjected to unnecessary medical interventions.
Screening is presented as best practice. But regular general health screening “check ups” have no scientific basis, serving only to highlight unimportant minor abnormalities, leading to more investigations, anxiety, and profit. As for mammography, one in three breast cancers detected are non-progressive lesions. This overdiagnosis causes women to have needless disfiguring surgery and chemotherapy.1 Similarly, the US Preventive Services Task Force recently called for an end to prostate screening after decades of overdiagnosis and unnecessary destructive surgery in men.2
Overdiagnosis is everywhere. In mental health especially, the Diagnostic and Statistical Manual of Mental Disorders is ever loosening diagnostic criteria. Swathes of children are diagnosed with mental illnesses, ranging from attention deficit hyperactivity disorder to bipolar illness, depression, and oppositional defiant disorder. The prescribing of powerful antipsychotic and potentially addictive stimulant drugs to children is a societal norm. The new DSM seems intent on subsuming the notion of normality all together, and already a quarter of US women are taking mental health drugs.3 I fear soon all those with even mild cognitive impairment will be labelled with dementia. This biochemical model of psychiatric disease is being exported and going global.
For diabetes, hypertension, and cholesterol even quantitative disease definitions have shifted downwards, because the best way to improve business and increase customers is simply to reclassify the “well” as “ill.” Currently, half of US residents older than 65 take three or more medications,4 yet adverse drug events cause more than 100 000 hospital admissions in the United States alone.5 Direct to consumer advertising can magnify the medical harm from drugs: as many as 139 000 US residents had heart attacks and strokes as a result of taking rofecoxib.6 The most glaring current example of iatrogenic harm is the prescription of opioid pain killers. Some 15 000 US residents die every year from unintentional opioid overdoses, and for every death there are 800 drug misusers.7
To question modern medicine is to be denounced as a heretical fool and to stigmatise sick people. Yet our duties are not only to the ill but also to protect the well. Medicine’s challenge for this century is to fight the pandemic of iatrogenic harm.
Cite this as: BMJ 2012;344:e2346