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Too much of a good thing?

By on February 27, 2010
Photo © Elena Derevstova
 
It is remarkable that a great deal of medical activity these days is directed not towards the treatment of illness, but to prevent disorders which may never happen. The Bible has some words of wisdom on this matter (Matthew 9:12): "They that be whole need not a physician, but they that are sick."
This is not in conflict with the saying "Prevention is better than cure" if the latter is taken to mean the common-sense precautions everyone can take to safeguard their health: Don’t smoke, don’t drink excessively, control your weight, eat a healthy diet, and exercise regularly.  On the other hand, modern ‘preventive medicine’ is much involved with performing ‘tests’ – doing things like measuring blood pressure and cholesterol levels.  The result is often the prescribing of drugs, perhaps for a lifetime. Is this safe?  We don’t really know.  

Before taking any drug there are three questions which should be answered to the patient’s satisfaction: What good will it do?  What harm might it do?  What harm might happen if I don’t take the medicine?  These questions may not be easy to answer, and often the decision whether to prescribe, say, a cholesterol-lowering medicine rests on a doctor’s experience and overall impression of the risks a particular patient may run.  It should be remembered that medicine is not an exact science.  

Medical tests to try to assess someone’s state of health are relatively crude.  They tell you the levels of cholesterol or blood sugar, etc., but this is not necessarily the same thing as knowing whether someone is healthy.  

The risks of treating healthy people are shown in the recent fiasco where for decades the menopause was regarded as a hormonal deficiency disease and millions of women were prescribed hormone ‘replacement’ therapy (‘HRT’).  It was thought this would prevent heart attacks and osteoporosis (brittle bones).  Rather belatedly, this huge uncontrolled experiment in preventive medicine was found to result in more cancers and heart attacks than in untreated women, and now as a routine treatment, it is totally discredited.  

What about preventing bone fractures due to osteoporosis in post-menopausal women?  A drug called alendronate (proprietary name Fosamax) may be prescribed for this purpose, and it has been claimed to reduce hip fractures by 50 per cent. Sounds impressive, but this is what is called "relative risk reduction"; what it means in practice ("absolute risk reduction"), is that in untreated post-menopausal women, the risk is reduced from 2 per cent to 1 per cent.  The risks of this treatment include digestive problems and a rare but serious condition of the jaw bone breaking down (osteonecrosis).  

To prevent fractures from osteoporosis, for most women, the best advice is that mentioned above, especially: Don’t smoke, and take exercise. When thinking of prescribing a drug, it would be well for doctors to keep in mind the plea of Napoleon Bonaparte (1820):  "I do not want two diseases – one nature-made, one doctor-made."

Note:  This article is for general information only and is not intended as advice to stop any medication which you may already be taking.  If you are in doubt about any of the treatments referred to above, consult your doctor.
   
Dr. Gabriel Symonds is the director of the Tokyo British Clinic, founded in 1992.  Full medical services are provided, including pediatrics.  General check-ups, with careful interpretation of the results, are also available.
Tel: (03) 5458-6099  www.tokyobritishclinic.com

About Dr. Gabriel Symonds

Dr. Gabriel Symonds was the director of the Tokyo British Clinic. The clinic closed down in May 2014 after serving the expatriate community for 20+ years. Dr. Symonds has retired and the Tokyo British Clinic is now closed. Dr Symonds will continue to live in Tokyo and may be contacted by e-mail over any questions concerning medical records or related matters: symonds@tokyobritishclinic.com He will be available from another address for: smoking cessation psychotherapy/counselling circumcision information Tel: (03) 5458-6099 www.tokyobritishclinic.com