Monday, October 12, 2009

Disease Mongoring

Bother, bother, there are not enough hours in the day!

Today I am going to make a mention regarding the treatment of osteopenia based on an article I read in the online journal BMJ. I want to highlight a couple of statements from the research that was conducted by scientists who are also health care practitioners, in Spain. This article was published last year.

In a recent blog post I discussed an ACSM article that explained different ways of promoting bone health and tailoring fitness programs to the clients stage of life. The article did cover osteopenia and osteoporosis. In the latter, careful attention is paid to preventing falls.

The number one risk factor for fracture is NOT osteoporosis, but falling. That being said, balance and core strengthening activities are always warranted.

The authors of the BMJ article offer some points to ponder. Their concern is one of disease mongering. Interesting term that! What they refer to is taking a risk factor, and calling it a disease. Once it is a “disease” it should be treated, yes? They say that the purpose is to market tests and drugs to persons with this risk factor. My my my. That could cover a lot couldn’t it? And we see it happen here every day and it may also be one of the reasons our health care costs are out of control.

Other conditions mentioned in this article are pre hypertension and pre diabetes. They call this being at risk for being at risk. For example, people with hypertension are at risk for a stroke while prehypertensive persons are at risk for hypertension which would THEN put them at risk for a stroke. And there has to be a cut off somewhere right. 120 over 80 is normal… 140 over 80 or 90 is treated with meds, well what about 130 over 80?

A study group of the World Health Organization which these authors refer to as small and not uninfluenced created a measure for bone health. They determined an average number for healthy younger women and decided that any standard deviation 2.5 below that, was osteoporosis and between 1 and 2.5 degrees was osteopenia – or a risk for getting osteoporosis. It is also noted that the measurement scale was meant for disease evaluation of populations (epidemiology) not individual risks. The score in other words should not be the determinant for treatment.

Drugs like Fosomax are absolutely advertised to women who do not have osteoporosis and fear messages are used by drug and device companies. Many doctors suggest that women who are very thin or post menopausal have a DEXA scan to measure their bone density for example and if the person is pre osteoporotic then medications are dolled out.

The drugs do seem to help with true osteoporosis, but the research that supports use in women who are at risk for it was not conducting independently. Drug companies used existing data, the same data that these researchers reviewed.

In their opinion, the risk of osteoporosis and fracture is over emphasized, the benefits of the drugs are not as great as consumers are led to believe and the risks of side effects are GREATER than we are led to believe. The authors stated that osteopenia is said to affect half of the white post menopausal women in the USA. Quite a money maker that would be. Basically, for these women, they would be taking an expensive medication that has side effects, which might reduce the risk of a fracture IF they fall down. I say, don’t fall down! Well, and eat wisely, exercise often and don’t smoke.

Again, this isn’t just about osteopenia, but about health care, pharmaceutical companies and diagnostic labs.

Be mindful now and see what other disease mongering and “medicalising” is taking place in our society. In fact, why don’t you see how many NEW diseases you can list that developed in the last ten years? Here is a start – RLS (gotta have a catchy abbreviation) or Restless Leg Syndrome, and Fibromyalgia. Not weighing in here, just saying that they are NEW diseases.

I expect that my brother in law is going to be thinking about cholesterol lowering medications because cholesterol numbers are another set that keep being revised down.

oops and now MNF!

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