OmniBlog

Are we inducing mass hypochondria? Making even apparently 'normal' persons suspect that they 'may' have some disease? Seek medical attention for diagnosis of prediabetes and prehypertension?

I wrote a response in 2005 to an editorial in the BMJ. Here's the text:

Dear Editor,

I have read the editorial by Westin & Heath and the subsequent rapid responses to that article with great interest. The extremes of views apparent in some of these are very bothering. At the same time, some of the statistical calculations were very humorous yet hit the bull's eye.

Let me first make it very clear that my views are very similar to those presented in the editorial. This notion has been bugging me for a long time. If the current trend continues we may reach a time when nobody may be considered 'healthy'. The WHO may need to redefine health in the near future. Currently it goes 'Health is not just absence of sickness, but a state of physical, mental and social wellbeing'. It may be changed to 'Health is not just absence of sickness, but absence of all risk factors for all possible sicknesses'. More than 90% of a population may be considered 'sick'. And then by statistical inference, those who are sick will be considered 'normal' and those who are 'healthy' with no risk factors will be 'abnormal' or 'sick'! How much more paradoxical and paranoid can it get?

I would also like to take this opportunity to respond to the letter by Raymond A Meleady, Consultant Cardiologist, published above. He has suggested that we need not wait for absolute proof, and has interestingly quoted the matter of the cholera epidemic. But Snow just turned off the Broad Street pump. Translating the analogy to cardiovascular risk reduction, we must absolutely turn off the 'Broad Street pump' of cardiovascular risk. I bring to his attention sedentary lifestyle, high fat diet and 'junk' food. Talking of analogies, the 'Broad Street pump' for respiratory illnesses is cigarette smoking, but I don't see anybody actually turning off the pump there!

Recently during the Iraq 'war', I visited the US for a conference on insulin resistance. One of the speakers, in the middle of the lecture, projected a slide - "Weapons of Mass Destruction Found in US!'. We were all flummoxed. It was a very uncertain moment as the speaker was not American. The next slide showed photographs of the major 'junk' food outlets that have originated in the US and have infested many other countries. It was a point very well made.

Now, that was another illustration 'Broad Street pump' of cardiovascular disease. But what have we done about it?

The picture is becoming clearer now. Any recommendation that advocates 'consumerism', applying that term even to prescription drugs, is wholeheartedly supported by the industry. Industry is the backbone of any Government. That recommendation becomes national policy. Vice versa is also absolutely true. To the best of my knowledge, there is no country in this World where cigarette sales are illegal.

What we are inducing is not mass neurosis. It is mass hypochondria. We can afford to have a more balanced and responsible view.

Regards,

Shashikiran Umakanth

This response by the cardiologist a little above what I have written on the BMJ responses page has the opposite point of view.