![]() Here in Michigan we hear the phrases “evidence based” and “best practices” and we have a new MIDashboard with metrics showing progress in the state on different issues. And he points out that marginal patients are “at extremely low risk to experience their ‘disease’ in their lifetime” but still face the “same risk of harm from treatment” and thus “these marginal patients are at extremely high risk not to benefit from treatment.” He concludes, “in short, low thresholds have a way of leading to treatments that are worse than the disease.” He calls “the person who has been turned into a patient because of a lower threshold” a “marginal patient”. Welch says, “the threshold for diagnosis has fallen too low.” “Physicians are now making diagnoses in individuals who wouldn’t have been considered sick in the past.” He cites the example where “a fasting blood sugar of 130 was not considered to be diabetes before 1997 now it is”. He describes how people who have no symptoms of a disease are tested for it, and how there have been changes in the level of abnormality that is considered to be disease. Gilbert Welch M.D., M.P.H., is a practicing physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and the author of “Overdiagnosed: Making People Sick in the Pursuit of Health”. ![]() It tells us that “low diagnostic thresholds lead people who feel well to be labeled as unwell.” “Not surprisingly, some subsequently feel less well.” “In short, low diagnostic thresholds introduce more ‘dis’-ease into the population.” A recent (May 6) Op-Ed article in the Los Angeles Times entitled, “Diagnosis as disease” brings out some very interesting points about medical diagnosis and thinking of people as diseased.
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