Medicalizing People -- and Mongering Diseases

The title of my monograph, "The Last Well Person" was borrowed (with his enthusiastic encouragement) from Clifton Meador.

In 1994, Meador published an essay in the New England Journal of Medicine in which he described a 53-year-old academic whose symptoms defy diagnosis despite extensive medical investigation. No other person in this brilliant parody is said to have escaped diagnosis.

Today, it's no longer a parody.

We are a country of obese, hypercholesterolemic, hypertensive, diabetic, osteopenic, depressed, pitiful creatures perched on the edge of a cliff staring at condors: cancer, heart attacks, strokes, dementia, fractures, and worse. We fear for our future. We teach our children that they, too, must live in fear for their future.

We mobilize all our courage when faced with creakiness, achiness, heartburn and heartache, headache and bellyache, constipation or diarrhea, impotence, sleeplessness, and even restless legs. No infant can simply be fussy and no child can simply be fidgety, obstreperous, or below average in performance. We are told that all these are symptoms of disease, or harbingers. We are a vigilant society.

We are also a modern people blessed by remedies. For us, mortality is an abstraction, a formless beast that we can bring to heel by the determined application of the latest and most convincing scientific insights.

Defining Our Diseases

All daunting, unpredictable challenges to our sense of well being can yield to a canny choice of ministration. We exalt our modern scientific medicine; our forefathers had but sages, often religious sages, pointing to the path to a good life, if not a longer life.

Today we wait, breath bated, for the next pronouncements of the biomedical establishment. Nearly all in our personal, intimate life that is untoward is now under their purview.

How are we to know if we are well, or still well? We are bombarded by the print and broadcast media with the scare of the week. We are bombarded by purveyors with the cure of the weekend.

Can we ignore these helpful people? They have taught us to be proactive. Can we ever ignore our body whenever it seems the slightest bit awry?

What's not a disease?

Something will go awry, and do so repeatedly, some alteration in our body that makes us question our wellness and that challenges our sense of invincibility. And each of us will die, usually carried off by one of several diseases standing between us and our 85th birthday. To be human is to be challenged in the course of living and to have it all come to an end.

What's not a disease?

To be well is not the absence of disease. To be well is to have some sense of invincibility; nothing, or nothing more will happen to me that I can't overcome.

Living in Fear of Death

Rare is the person whose sense of invincibility cannot be rattled, if not pulverized by the voice of authority.

When the authority is medical, and there's little or no valid reason for alarm, it's called medicalization (as opposed to chiropracterization, or physical therapistization, or naturopathization, or ...) When you should be reassured, but instead, you are taught to fear, that's disease mongering.

None of this is new.

Your parents and grandparents confronted medicalization and disease mongering. For these past generations, orgasm and thinness were medicalized. Today, both are normal, while lack of orgasm and chunkiness are medicalized.

At the turn of the 20th century, Graham had invented his cracker, Kellog his corn flakes, Mesmer his magnets and hypnotism, Still osteopathy, Palmer the chiropractic, Mary Baker Eddy, Christian Science, and so much more.

All of this, and the Pentecostal movement, played on fear of illness and death. Today, the vernacular is riddled with scientific inferences spewed by physicians and metaphysicians.

There is no better scientific support that screening you for high cholesterol, diabetes, osteoporosis, or breast and prostate cancer will help you than there is for nutraceuticals, Asian cures, poking and prodding, Echinacea and garlic, glucosamine, vitamin E and the like.

Sectarian gobbledegook competes with the medical gobbledegook for your vulnerabilities. Neither camp is above disease mongering.

How about some reality testing? The death rate is one per person, and the time of death is set near to your 85th birthday. Any claim to a science that offers a path to longevity beyond 85 years is fatuous.

The best we can expect is to arrive at our 85th birthday feeling reasonably well, even healthful, regardless of our burden of disease.

Modern medicine has something to contribute to our quest for longevity thus defined, but not much -- and certainly not as much as we are told. If we fall victim to diseases that threaten and damage our tissues and organs, modern medicine offers cures for some and important comfort for others.

However, most personal predicaments are more disconcerting than damaging. What we should do to cope -- and to whom we should turn -- is less certain, even contentious.

Your Choices, and Your Concept of Wellness

One choice is to try to "deal with it," to cope in our fashions. From every side, from family members, from the lay press, from purveyors of sundries, from purveyors of treatments, we will hear of options in conceptualizing the predicament and in palliation.

All this fuels our common sense. We have only prior experience and conviction to comfort us until we are better, or until we yield to all the advice.

Then we can choose to seek care. For most personal predicaments, there is a menu of providers. Each proclaims a theoretical underpinning. Each has a privileged language. Each offers an assortment of modalities that are applied with a skill said to reflect specialized training.

For most of the predicaments of life, from fatigue to back pain, nearly all the modalities are ineffective, a few are minimally effective.

What may be effective is the act of being treated rather than the treatment. We will learn the language and conceptualizations of the professional into whose hands we have consigned ourselves. Our self-image will change, as will our idioms of distress and of wellness. We will be different.

If you have chosen to entrust your care to a physician, you will be medicalized. Not all physicians are comfortable with this process. Many would rather reassure you than diagnose you and prescribe something that "might" work. These are the physicians who would like to tell you, "It's miserable, but it's not evil. Get on with life as best you can. It, too, shall pass."

Can you countenance such? Or would you rather be medicalized?

Dr. Nortin M. Hadler is a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and attending rheumatologist at the University of North Carolina Hospitals in Chapel Hill, N.C. He is author of "The Last Well Person."

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