Hyper-vigilance is never a good thing. It fits under the category of “too much of anything is a bad thing.” There are more and more people lately who watch their health far too closely to actually remain healthy, which seems a bit like setting yourself up to fail. With sites like WebMD out there and others just like it, you can look up your symptoms in moments and discover a whole host of things that might be wrong with you. But maybe you just have a cold. There’s fitness apps out there to make use of also, including many you can wear on your wrist that upload data in real-time to your computer. We are slowly becoming cyborgs here. There is nothing health related that you cannot track or look up anymore on your own. There’s a reason however, that Doctors need so much schooling just to be one, and if we could do it ourselves there would be little need for them right?
A study on patient harm and medical issues was done to shed light on how people are not helped by tracking their health so closely that it causes concerns constantly. It leads to more trips to the doctor, more blood tests, over-diagnosis, over-treatment, perceived distress over an ailment that may not even exist, false reassurance due to a false negative during testing, psychological issues with having a label for what is wrong, and problems with medical insurance premiums. It does us no good at all to have a symptom like a cough and a sore chest and then type that into a medical site’s search terms. What comes up? Find out yourself, give it a try right now: the results will likely surprise you. This is particularly bad for people who are more likely to feel or experience pain, or suffer from worse than normal illness due to persistent allergies, or other compromises in the immune system.
This is also backed up from the Society of General Internal Medicine who also say that more testing ends up in more false results because no test is ever 100% positive, and incidental findings leading to abnormalities that are not harmful to your health which leads to the probability of more treatment. By treating something you don’t need to treat, you increase side-effects, and those side-effects could result in making you feel worse, so you treat those too. It is a never ending cycle of feeling terrible, and worse – it’s expensive.
The very same site that will tell you from a cough and a sore chest that you could have anything from the common cold to whooping cough or tuberculosis, is also saying the same thing in other areas. By illustrating how parents should not remain hypervigilant in watching how their baby is growing. Dr. Daniel Kessler, the director of developmental and behavioral pediatrics at The Children’s Center of St.Joseph’s Hospital in Phoenix, Arizona said that no child is average, so watch your child, but use your instincts too. An average is compiled from millions of sources of data potentially, with ranges from severe ends of the spectrum, most of us falling within the middle. There may be some closer to what is considered the average but nobody who is “normal” for being in the middle. Normal just means healthy in the healthcare field, and it can lie anywhere between two extremes or more.
NPR (National Public Radio) which is a private and publicly funded non-profit membership media organization serving as a national syndicator in the USA of 900 public radio stations, recently conducted an interview with Dr. H. Gilbert Welch from The Dartmouth Institute for Health Policy and Clinical Practice about this very thing. A summary of that interview is what follows. When asked about quarterly blood work, Welch said that it’s a potential recipe for making all of us sick. “We all harbor abnormalities, and increasingly our technologies are able to detect them – be they biochemical, be they structural. We can see things down to millimeters in size; we can measure things down to parts per billion; and we can sequence the whole genome. That’s 3 billion data points.
So there’s no shortage of biometric data that people could be collecting on themselves regularly, and by the way, there’s a huge financial interest in having people do that. The market of the well is a huge, huge market.
The problem is you’ll always be catching things out of what we would say is normal. This is anticipatory medicine at its worst, where you’re really focused on what could be going wrong in the future and you’re trying to pick up [a]signal.
The problem is there’s so much noise – because the human body is a living organism. Variation is the very essence of life. People will start reacting to this data. I also think it’s really important to label it what it is: data. To me it only becomes information to the extent that it accurately predicts something will happen in the future, and it only becomes useful knowledge – a higher level piece of information – if we can do something about it.”
NPR cites Mark Cuban (owner of the Dallas Mavericks) regarding his Twitter post (and the subsequent backlash which you can read clearly) suggesting that quarterly blood testing could help healthy people stay that way. It is for this purpose he is referred to as Cuban in regard to the remaining part of the interview. He continues to rant at the many professionals who responded, citing data from scholarly sources like Stanford, but the issue isn’t whether blood testing can determine early diagnosis of actual major problems, the issue is that by being constantly concerned about health can actually be more harmful due to the many reasons listed above, from people actually in the medical field, rather than simply a business owner.
NPR asks: “Cuban argues that any misdiagnoses and unnecessary treatment rests with the doctors, and not with patients owning their data. Do you agree?”
Welch responded with: “I think there’s a misunderstanding that diagnosis is some super clear black-white kind of distinction, when in fact there are 1,000 shades of gray in between. The time you get into that gray is when you’re dealing with people who feel fine and have some detectable abnormality. That’s how we get into it in cancer screening. We’re looking for very early signs of disease. There’s going to be great pressure to react to those abnormalities.
It’s not fair to say the pathologists have misdiagnosed. Undoubtedly there is some misdiagnosis, but their standard for what constitutes cancer is the appearance of individual cells, and how they relate to one another – the architecture of the cells. That was a perfectly good standard when you were sending them cancers that you could feel, things the size of golf balls. But when you start sending them microscopic collections of cells, expecting them to make some prediction about the dynamics of that process and how that will interact with the host – that’s you – it’s understandably going to be fraught with uncertainly. It’s all going to be probabilistic.”
NPR: “Some people say that medicine needs to move away from paternalism and more toward individual ownership of health. Patients want access to their own data, how and when they want it.”
Dr. Welch: “I’m a great believer in having patients share in decisions. At the same time, since I’ve actually cared for patients, I know that many times they’re sick. They actually want to know what your advice is. It’s too easy for doctors to come back and say, ‘What do you want to do?’ Obviously we have to find a balance between something that’s totally on the patient to try to decide … and the doctor simply asserting what the patient should do.
I think most patients want to be somewhere in between. They want to participate in the decision, and when there really are close calls, they want to participate in the close calls. We should recognize that some patients will want to do that more than others, and some patients will be more capable of doing that than others.
We should also be clear that there’s a lot of bad information out there.”
The most important thing to take from all of this, is not to throw away your fitness apps, or to avoid regular Doctor visits for checkups or when you have a valid concern warranting a trip, like when something completely out of the ordinary has changed, it’s that you should not be so focused on your health that you begin to suspect things being wrong when you might just be fine, or to take results like “pre-cancerous or potentially cancerous cells” as saying you categorically have cancer. A growth might just be a growth, it could be a fatty cyst, it’s probably harmless. It doesn’t mean you shouldn’t get it checked out if it concerns you, just that if they tell you it’s a growth, it doesn’t automatically mean it’s fatal. If the healthcare industry was flawless, we would all be shining beacons of beautiful health, clearly there is still work to be done, so take all the information you gather with a grain of salt.