Over-diagnosis and Pluri-Pharmacy
Over diagnosis of illnesses and conditions is finally being recognised by main-stream medical doctors and nurses. Over=anxious patients are demanding more medication and treatment. .The outcomes for patients taking too much medication is poor.
When, sadly, someone dies, families are finding huge amounts of medication, untouched. These, of course,, have to be thrown out. No point in taking them back to the pharmacies, because they are precluded from using them, although they are unused and unopened..
I have looked at studies carried out in Canada, Australia, Norway, the USA and the UK. China is waking up to the fact that they, too ,have an ageing population who are taking huge amounts of medication., with the same negative outcomes.
What are the most over-diagnosed conditions?
1. Chronic Kidney Disease
2. Low Testosterone
4. Some cancers-Thyroid/Breast/Prostate/. Polycystic
5. Mental Illness-many conditions have been up-graded to Mental Illness
7. Irritable Bowel
9 .Middle Ear infections
In Australia, the definition for over-diagnosis is when someone is diagnosed with a disease that is not fatal and will not cause undue harm and where the treatment can cause more harm than the condition itself.
This happens because people are tested more often.
If you keep going in to the Barber shop, you will eventually end up with a hair cut..
Early diagnosis is a two edged sword . Researchers are investigating the size of this problem. It is generally accepted that approx 25% are over diagnosed and this is on the lower estimate.. The various scans and tests can detect smaller abnormalities, especially small tumours. Many of these will never develop into full cancers, nor do they cause pain or discomfort. . The NEJM estimates that over 500,000 people have been over-diagnosed for Thyroid Cancer.
For ADHD, a study of over 1 million Canadians diagnosed with ADHD found that people, especially boys, born in December were more likely to be diagnosed. A re-examination of the data revealed that these might just be developmental delays and being given the label and the medication was actually damaging to these boys.
The data for Prostate Cancer goes back over 30 years. Many men can die with Prostate Cancer rather than from it. Despite the evidence, the push to test healthy men, with few or no symptoms continues, followed by treatment which often exasperates the problem.
Up to 21% of women in Australia were diagnosed with Poly Cystic Syndrome. The figures themselves prompted alarm and further investigation with a finding of over diagnosis. Doctors in Norway, Britain, Canada, Australia and the USA are more aware now of the over diagnosis of Breast Cancer, causing huge, unnecessary distress. It appears that the rush for early diagnosis is propelled by the Insurance companies . Now. these are starting to analyse the data they have to see what the correct path should be.
And now we come to the over-diagnosis that resonates with me-Osteoporosis.
Not only has this condition been over diagnosed.but it has also been classed as a disease which it most certainly is not. The bone density is measured and compared to the results for a young healthy woman. The treatment dates back to a study done on France which measured the incidence of fractures in elderly women of average age 85. The failure to make the distinction between primary and secondary fractures skews the result. The terms fragility and osteoporosis are used inter changeably. The testing is driven by the Pharma companies who provide large doses of calcium and vitamin D, both of which are difficult to absorb and over taking can result in an increase in heart attacks, strokes,, nausea, gastrointestinal complications and kidney problems especially kidney stones. Non pharmacological interventions are overlooked-Life Style, Diet, Exercise, tobacco and alcohol consumption. Another danger revealed in the studies carried out in the USA and Australia is the Fear Factor in women, who afraid of falling and breaking their spines/hips, /wrists/legs/feet, become less active and think of themselves as fragile or weak which becomes prophetic-going back to the Barber shop and being surprised at getting the hair cut. . The research shows that women thought that bone scans were scientific and clear cut. They were not aware of the over diagnosis and even though they had not experienced any symptoms, immediately curtailed their life styles and put up with the side effests of the medication as a necessary evil. The women suggested that instead of classing Osteoporosis as a disease, it should instead be referred to as a risk factor. Post-menopausal women experience loss of bone density due to lower testosterone. Those that have taken HRT tend to have less loss of bone density.
A review of over 50 test trials carried out on a varied age group of women from 50-85 showed that while small increases in bone density could be seen in some women, the actual number of fractures was not aligned to the taking or non taking of calcium and vitamin D.
So what to do?
It was found that 500-600 is sufficient for a calcium supplement which will provide some benefit and avoid the complications. Most of the calcium currently being prescribed is between 1000 and 1200. Vitamin D, which can be difficult to absorb from non solar sources, should only be taken in doses of 600-800 per day.
Instead dairy, vegetables rich in calcium and vitamin should be taken. Walks outside without sunscreen in the fresh air are encouraged, possibly in a green area. The presence of foliage, trees, grass and flowers increases our sense of well being.
Bone strengthening exercises are recommended, even using light weights of cans of tinned peas to build resistance. Walking straight rather than leaning forward. When we lean forward, we are almost falling so best to re-arrange your weight straight down the spine.
Pluri-Pharmacy- The Cascade Effect
As if that was not bad enough, in countries where the population is ageing and that includes Africa, where because the population is huge, also have a growing ageing population for which they are not prepared., but are interested in adopting strategies which encourage a better quality of life. The high cost of medication is encouraging many Health providers to look at other methods.
Elderly people are at greater risk of adverse reactions to drugs because of the metabolic changes in their bodies and reduced capacity for clearance. According the the World Health Organisation, WHO, over 60 is elderly. This might come as a surprise to some.
Because the majority of elderly people live in low and middle income countries, the WHO have conducted their own investigations. Multiple chronic diseases are routinely prescribed 3/4 different medications. If the person has multiple chronic conditions, they may be taking anything from 6 to 12 different drugs. The prevalence of inappropriate medication used by elderly people was found to be between 12 and 62% This rang alarm bells and new guidelines were drawn up. All drugs should be re-evaluated monthly. They should be introduced on a low dosage.
Watching the diet is essential and trying to eat a varied diet with lots of fiber, vegetables, fruit and some meat to build up protein. , While organic farming is better for the soil, farm workers and the planet, it appears that the food is not more nutritious. However it does taste better. Except for organic cauliflower!