Test me! Treat me!

I am about to go off to the dentist for a routine hygiene/ cleaning appointment where, once again, I will be told I need a new set of x-rays, and once again, I will decline. I take good care of my teeth, see my hygienist three times a year, have no problems/ symptoms, and submit to x-rays every 3 years or so. That is ENOUGH.I was thinking about this “testing for everything because we can” approach to medicine after reading Barbara Ehrenreich’s bold essay on “Why I’m giving up on preventative care.” She goes too far for me. I don’t see a colonoscopy as rape-by-machine, and frankly I’d rather have an innocent polyp removed than hang around waiting for it to maybe become something. And her point about testing and treating to prolong life doesn’t resonate with me. I am not interested in prolonging life. I am interested in prolonging good health. (Those of you who’ve heard me speaking about this or have read my book, Counterclockwise, know my favorite geeky term for this: rectangularization of morbidity.)But Ehrenreich makes many good points in this essay. As testing gets more and more sophisticated, the chances for finding something increase. Whether than something is worth worrying about (let alone aggressively treating) is another matter.This relates to two other health and medicine issues I’ve been contemplating, the value-added component of living with a science writer.The medicalization of our lives. In above-mentioned science writer Tom Hager’s words (from his upcoming book chronicling 10 drugs that changed our world) this is “a troubling trend in our society, in which things that we once simply dealt with on our own – like lifestyle choices, low-risk health conditions, personality quirks – are now being turned into treatable medical conditions. Often this goes hand-in-hand with the appearance of a new drug suited to treating the new condition.” Everyday anxiety, for example. Classroom misbehavior. Or, gee, how about menopause?Disease mongering. This is emphasizing or redefining the risks of disease to enlarge the market for medications. For example, even though medical researchers have known for many many years that the total cholesterol number is meaningless, that “number you should be scared about” has gotten lower and lower. When just about everyone is at risk, that means everyone should be treated preventively, right? As Tom Hager writes: “Minor problems can become major money-makers for drug companies. With a much larger group of potential patients getting increasingly worried about their risks, the market for the drug grows. Blockbusters can result.” Cholesterol-reducing statins are blockbusters.Now we have entered into the world of sophisticated mail-in genetic testing, where I can discover (if I want to) all the disease demons lurking in my DNA. Oh boy. I think I'll just eat an apple and go for a run.