Medical treatment

Are too many medical treatments harming our health?

Undoubtedly, one of the most significant achievements of the last hundred years is the improvement of the health of the population. Under Queen Elizabeth II we live almost twice as long as under Queen Victoria.

Like all advancements, it reaches a point where the fruits at hand have been easily picked and any further improvements are hard-earned. This creates a very real danger of overdiagnosing and providing too much treatment. Anyone visiting their GP recently has probably experienced this, as they are subjected to a battery of tests, many of which are of the ‘just in case’ type, rather than being critical of the issues presented.

And this is mild compared to more severe forms of overdiagnosis and treatment. Take the example of menopause, rightly hyped after being ignored and considered a taboo subject for so long. Most of what we hear about menopause is about the negative experiences and symptoms that some women suffer from.

However, the journey through menopause is not a universal or standardized experience. While some women will suffer from this, there are many others who are unwilling or unwilling to take hormone replacement therapy as a treatment. Like any treatment, it is based on a calculation of risks and benefits.

While it is obviously good to ensure access to treatment for women who need it because of menopause, too much emphasis on this subgroup creates problems. The perception is fostered that menopause will be negative, impacting not only a woman’s body, but also her mind.

In this sense, it can lead pre-menopausal (perimenopausal) women to believe that they will inevitably experience the negative aspects of menopause that they have heard about and read about, although many will not. Also, the positive aspects of menopause are often lost or at least not given the same attention as potential adverse symptoms, such as missed periods, which reduces the chances of pregnancy and the need for contraception.

I am not saying that the problems experienced as a result of menopause can simply be overcome with a positive mental attitude, but rather that we need to bring balance when discussing the problem and ensure that this natural occurrence does not become too medicalized.

There are other examples where women’s health has gradually become medicalized, including childbirth. Many women’s lives and those of their newborn babies were saved through medical intervention, but it came at a cost to the many others who suffered unnecessary surveillance, invasive testing, and more.

In a system as megalithic as the NHS, which has developed a culture of risk aversion, all the ingredients are in place to overdiagnose and overtreat – to the detriment not only of the health of the individual, but also of the wealth of the nation. Health care is expensive and should be used sparingly.

Research that informs new practices and procedures is based on averages rather than outliers. If you happen to be just a fraction outside the parameters of the average, chances are you’re not feeling the benefits of original research.

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A useful example is antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), a new generation of pills. We know that a third of people will not benefit from an SSRI. Although the good news is that two-thirds will benefit, both groups will receive multiple types of SSRIs before they either achieve this benefit or realize they will get nothing, regardless of the type of SSRI prescribed. .

This can take months and at a time in an individual’s life when the need for symptom relief is most acute. In addition to this, the first few weeks of taking an SSRI are when the adverse effects are greatest, and the benefit of adherence is still not realized.

The fact is, we still don’t have the knowledge or ability to determine in advance who will or will not benefit from these types of drugs. That’s without getting into the question of how, for many people, the causes of depression are social and environmental – which makes it fanciful and cruel to suggest that a pill will somehow solve these underlying issues. This is another type of overtreatment that has engulfed millions of people in recent years.

We should recognize the advances that medicine has made, but also recognize that there are limits to what can be achieved.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York