Are we all sick? Doctors debate "medicalization" of life

Human conditions previously thought of as normal now warrant treatment. Medical guidelines are being expanded. And genetic tests are turning more people into patients.

By Victoria Stagg Elliott, AMNews staff. Sept. 20, 2004.

A decade ago, Clifton Meador, MD, predicted that it wouldn't be long before there wasn't a single healthy person left in the United States. Now his forecast might have come to fruition.

"I don't know the last time I saw a really well person," said Dr. Meador, director of the Meharry Vanderbilt Alliance in Nashville. "Everybody's got something."

Ever since making his prediction in a fictional case study, "The Last Well Person," which appeared in the Feb. 10, 1994, New England Journal of Medicine, he has become part of an increasingly vocal group of physicians uneasy about the growing medicalization of life in the United States and the rest of the industrialized world.

Previously typical vagaries -- such as menopause, shyness, shortness of stature or the symptoms of old age -- are now worthy of medical intervention.

Thresholds for cardiovascular disease risk factors such as hypertension and cholesterol have been lowered, leading an increasing number of people to be categorized as "in need of treatment" or to qualify for precursor conditions such as pre-hypertension.

Cancer screening now can detect more and more precancerous lesions. And genetic tests that are starting to become available have the potential to add more people to the ranks of those with disease labels that can be given long before symptoms appear.

Some physicians don't like it.

This kind of medicalization is a threat to health, turning the United States into a nation of overtreated, worried well who are unable to cope with life's normal travails, argues Nortin M. Hadler, MD, professor of medicine, microbiology and immunology at the University of North Carolina. He borrowed, with permission, the title of Dr. Meador's paper for his new book, The Last Well Person: How to Stay Well Despite the Health-Care System.