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Overtreated and Overdiagnosed

The more you look the more you will find.
The more you find, the more you will treat.

There is a backlash in America, not only in the financial sector, but in the medical arena as well. Lately, I have seen (and read) books and articles with titles like Worried Sick: A prescription for health in an overtreated America, by Nortin M. Hadler, M.D. and Should I Be Tested for Cancer? Maybe Not and Here's Why, by H. Gilbert Welch, M.D. This is going to sound heretical, and please don't do as I do unless it feels right, but I don't get any of the usual diagnostic cancer screenings. I believe that screening would put the focus on fear and potentially increase my chances for manifesting the disease. As I have already said, I don't recommend this for everyone, but I have come to the conclusion that 1) I won't buckle to fear diagnostics and 2) I lead a very healthy lifestyle and am not at any significant risk for malignancy and 3) I have to die someday.

No colonoscopy for me. Or fecal occult blood, mammogram and bone density (although I may change my mind about this one since I have had great success in reversing osteopenia and osteoporosis with natural means, so I might as well know where I stand.) However, I did ask for an ultrasound of my abdominal aorta because my father had a ballooning aorta with a surgical intervention and sometimes this type of aneurysm is inherited. I am suggesting here that we not be stupid about having the appropriate tests if needed or desired.

I have a good relationship with my Kaiser doc and ask her quite often to order me routine blood work, checking markers like hs-CRP, homocysteine, fibrinogen and vitamin D levels and if I find myself mentally nattering about an imagined symptom, I will get it checked. My latest medical preoccupation was two achy quads and I wanted to rule out Peripheral Artery Disease (PAD), so went to my lovely Kaiser doc who felt a few relevant arteries in my legs and pronounced them very healthy. Again, nocebos -the opposite of placebos - are extremely powerful so if I find I am having scary and self-sabotaging thoughts, I check them out so that my worst fears don't become my most ardent prayer. See Hot News/We Are What We Think.)

Sadly, prevention isn't what it used to be. It used to mean keeping yourself healthy by promoting healthy habits - like exercise, balanced diet etc. But nowadays the medical model for prevention really means getting yourself tested for anything and everything that Big Pharma has an expensive drug for. It seems that Big Pharma and medical centers see preventive medicine as a wonderful way to turn ordinary "Joe the Plumber" into a patient - and a paying customer.

The current mantra is almost feral in nature: "Let's get that early diagnosis!" However, too often early diagnosis leads to over diagnosis and over treatment for an ever increasing list of possible problems. Early diagnosis may help a few, but it certainly leads others to be treated for "diseases" that would never have bothered them and that is what is called overdiagnosis. Here's the thing: Almost anyone who receives a "diagnosis" receives some sort of treatment for said "diagnosis", and sometimes the treatment makes everything worse.

Dr. Welch puts it this way: "Early screening is like the 'check engine' light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don't affect performance, like one sensor recognizing that another sensor isn't sensing. And, if we look hard enough, we'll probably find out that one of your check-engine lights is on."

Then we are off to the races, with more tests, perhaps some invasive, perhaps some even surgical. All the while, what are you, dear patient, feeling like? Crap, that's what you're feeling like, because now, you, a formerly happy well person, are sick with worry. Underneath that morbid disguise of a treatable "diagnosis" is actually a well person who made a bad yet well-meaning decision to try to find some sort of "check engine" light on. With our sophisticated testing procedures, you'd better believe that, if you let them, some one, some test, some procedure will find a check engine light on.

Dr. Hadler has a pretty rock solid premise on which his book is based and that is we are all going to die and "holding every dire illness at bay forever is simply not an option." The real goal is to reach a nice old age of say, 85 more or less intact. According to Hadler's statistics, the best way to do this is by ignoring the screeching implorations of the medical community to test, test and test some more. He has found, and has convinced me, that most of the widely endorsed medical truths about routine testing "come up too short on benefit and too high on risk to justify widespread credence." He also thinks that the yearly exam is "entirely useless."

Dr. Hadler has a chapter in his book where he discusses routine colonoscopies and at one point, he says, "Give me a break. Let my polyps go." Then he goes on to say: "About 1% of people at age 50 have at least one polyp, and the population acquires polyps at a rate of about 1% per year after age 50. We also know that at age 50, a person has about a 2% chance of dying from colorectal cancer over the next thirty years. And we know that at age 50, a person has about a 60% chance of dying from all causes over the next 30 years.!"

Always supported by his basic premise that we all have to die sometime and 85 is a good number, what he is saying is this: Is the colonoscopy and all the attendant risks worth it, considering the above stats? Your gastroenterologist would, of course, say yes. Here's more about your colon: "If you rely on Fecal Occult Blood Test as a screening modality, you would have to screen about 1,000 people over the age of 50 for a decade to spare one death from colorectal cancer - and you would still not decrease all-cause mortality." The figures for routine colonoscopies just don't add up for a well person. However, I recommend that if you have a family history of colon cancer, by all means get yourself checked out.

I could go on and on about this subject, but the bottom line is this: You have to make up your own mind about routine well-checks. In this case, don't do as I do or say, but while you are figuring out what to do, buy yourself a blood pressure cuff and make sure your BP is in the normal range, don't eat sugar or drink too much alcohol if at all, stop smoking, keep your weight down, exercise, reduce your stress levels and find a way to sleep well. And with these small but meaningful intentions, all manner of health will be yours for the asking. Oh, and if you are obsessing about something, by all means get it checked out by me or an M.D.

On to something more fun: Many of you have asked about my recipe for Bug Blaster, used for gargling and swallowing in the case of sore throats, colds, flu's etc., so here it is. It's not brain surgery, and there is no way that you can do it wrong, so just start throwing stuff into the blender. Try to get all organic if you can.

1 very large white onion, roughly cut up.
A handful of very hot peppers (jalapeno, habanera etc.), washed and roughly cut.
A big piece of horseradish root washed, unpeeled, cut up. (Maybe 5 inches long)
A couple of heads of garlic, unpeeled, separated.
A big piece of ginger, washed and unpeeled, cut up. (Maybe 5 inches long)
All this goes into the blender.

Add organic apple cider vinegar, enough to cover what's in the blender. I have a Vitamix which holds a lot. Blend the mess up until it's a slurry. Pour the slurry into a huge jar (I use a two quart mason jar), put a lid on it and let it sit on your kitchen counter for a month, turning it upside down and swishing it about every day or so. When it's done, strain and decant just the liquids into whatever containers you want to use. At the first signs of a cold, start swigging, swishing, gargling and swallowing. Bug Blaster works! It will last for at least 2 or 3 seasons if you refrigerate it.


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