Please read this NY Times op-ed – If You Feel O.K., Maybe You Are O.K.

The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer … is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms).

This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.

He goes on to argue that true prevention involves health behaviors – exercise, diet, avoiding cigarettes, substances of abuse, etc.

This argument makes some sense.  He has it mostly correct.  We do need strong secondary prevention.  Once we have a diagnosis, then secondary prevention becomes important and useful.

So the argument should focus on primary prevention.  Some primary prevention seems to make sense – colon cancer, measuring your BP and starting treatment once the BP exceeds 140/90, etc.  But other primary prevention concepts do not seem to work.

We should put more money into planning that encourages walking, healthy eating and discourages smoking.