Many diseases in the US are not actually defined by symptoms we experience, but by values determined through testing. It is obvious, once you think about it for a moment, that if you narrow the “normal” range on the test, then more people will fall outside that normal range and thus will be a candidate for treatment. And, shocking to exactly no one, that treatment will likely bring billions of dollars of additional revenue into the medical machine.
First, consider osteoporosis. With a strong tendency to be diagnosed in women over the age of 50, about 1 million women are diagnosed with osteoporosis annually in the US, and another 2-3 million diagnosed with more mild bone density loss called osteopenia. And how is this diagnosed and treated?
Diagnosis happens with a DEXA scan, introduced clinically in 1987. You might be surprised to learn that the diagnostic criteria for osteoporosis and osteopenia were developed as recently as the 1990s. DEXA is a radioactive bone scan that is said to determine bone density. Once tested, everyone assessed, regardless of age, has their DEXA result/bone density compared to that of a 30-year-old female.
Why would/should a 70-year-old female have the bone density of a 30-year-old? It makes no sense, unless the goal is to sell medications that supposedly increase bone mineral density. The question is, though, do those medications reduce fractures? That is not so clear. A strong case can be made that it is preventing falls, regardless of bone density, that reduces fracture risk. By equating reduced bone density with fracture risk, an booming industry was born.
Note: I’m not saying there is no such thing as brittle bones or a dangerous loss of bone mass that can develop in some. I’m saying there is more than a concern about health behind what level of bone mass loss qualifies as a disease.
Next, consider cholesterol. When I was in naturopathic school (over two decades ago!) the interpretation of results on a lipid panel (measuring total, LDL, HDL, and non-HDL cholesterol; and triglycerides) took all values into consideration. With the advent of statin medications and their ability to lower LDL (“bad”) cholesterol specifically, LDL has become the singular focus of the lipid panel. I have had dozens of patients over the past decade who had been prescribed statins due to a modest elevation of their LDL, even though very commonly their other lipid values, inflammation markers, diet, lifestyle, and/or supplementation indicated very low risk of a heart attack.
Statin medications are not without their potential adverse effects. One study found that among individuals with early mild cognitive decline, taking certain statin medications more than doubled the risk of being diagnosed with dementia over the course of eight years of observation.
Labs and testing like DEXA can be a blessing and a curse. If you know how to interpret multiple labs in combination you can discover a great deal about an individual’s health. If you follow the one-lab/one-disease model, you easily become a customer for various medical interventions, a source of revenue for everyone involved except you. If you’d like help sorting through what your labs or imaging results mean, set up a conversation with me. I can talk you through age-appropriate values for your labs and imaging and point you toward non-pharmaceutical therapies documented to help address whatever your underlying risk might be. Schedule at https://gregnigh.com/schedule, email drnigh_info@gregnigh.com, or leave a message at 503-719-4806.
