The Medicalization of Common Conditions
Some time ago, the Diabetes Prevention Program and other studies found that people with impaired glucose tolerance (based on a 75-gram oral glucose tolerance test) can decrease their risk of type 2 diabetes eventually developing either by an intensive supervised lifestyle intervention, including diet and exercise modification, or by metformin hydrochloride treatment.
As a result of this research, the glycemic criteria for prediabetes were expanded to include a decreased level for fasting glucose, among other changes. Although the benefit of type 2 diabetes prevention is unclear in this broader group, the Centers for Disease Control and Prevention, American Diabetes Association, and American Medical Association have promoted a web-based risk test to evaluate people at high risk for prediabetes.
JAMA Internal Medicine, as part of its ongoing Less Is More series of thought pieces and research articles aimed at calling out over-prescribing and over-treatment, estimated the proportion of the adult, nondiabetic U.S. population that would suddenly be classified as being at high risk for prediabetes.
The Less Is More series is concerned about the “medicalization” of common conditions. They in fact found that the widely endorsed prediabetes risk instrument would label more than 73 million Americans, including more than 80% of those older than 60 years, as being at high risk for prediabetes, a condition never heard of 10 years ago.
The study authors suggest a better approach to preventing obesity and its health-related complications is “emphasis on healthful diet, weight loss...and increased physical activity at all levels—by schools, the medical profession, and public health and governmental agencies.”
The medicalization of common conditions is an issue far broader than just prediabetes, the concept of which arguably has much merit. Turn on the TV and find a cable news show running any midday during the week, and the parade of new prescription drug commercials—with their comically long list of side effects seeming to far outweigh the “solution” to the condition advertised—is relentless. New medical conditions seem to appear daily.
Now, such common conditions as menopause, pregnancy, infertility, erectile dysfunction and beyond are routinely weaponized to sell evermore medications. Over the last several decades, these conditions have come to be defined and treated as medical problems. In a study published several years ago in Social Science and Medicine, Brandeis researchers used national data to estimate the costs of these and a handful of other common conditions on escalating U.S. healthcare spending.
The researchers evaluated 12 conditions that had been defined as medicalized by physician organizations, and for which there were current medical spending data. The other conditions considered in the study were anxiety and behavioral disorders, body image, male pattern baldness, normal sadness, obesity, sleep disorders and substance-related disorders.
Among the medical spending analyzed in the study were payments to hospitals, pharmacies, physicians and other health care providers. They found that these expenditures accounted for $77.1 billion in medical spending in 2005—just under 4% of total domestic healthcare costs.
The study did not attempt to directly assess whether medicalization is good or bad for health and society. Yet it demonstrates the need for understanding just what the impact is, both societally and economically.
By estimating the amount spent on medicalized human problems, the important question has now been raised as to whether this spending is appropriate. It seems likely that soon the medical community may be considering policies that curb the growth of spending on at least some of these new conditions.