Too much medical measurement?

Following a couple of recent high blood pressure readings I had a 24-hour monitor test which was reported as normal – a great relief. I don’t know whether my various small lifestyle changes had made a difference, or whether the previous reading was the result of ‘white coat hypertension’ at the clinic, or of an inaccurate machine at home. I’ll keep an eye on the situation – and continue the improvements in diet and exercise, and with following the mantra NO NEED TO RUSH.

I am uncomfortably aware that many other people are taking long-term, even life-long, hypotensive medication on the basis of just one single high reading without having the 24-hour test – either because this wasn’t suggested to them, or because they couldn’t afford to pay for it.

Many medical screening tests besides blood pressure checks are advocated today. Occasionally, they detect an early case of serious disease which can be successfully treated. This life-saving benefit for a few people has to be balanced against the downside for many others – a widespread increase in health-related anxiety among the ‘worried well’ and the practice of treating risk factors and borderline abnormalities in the same way as established diseases, although in the majority of cases they might never have progressed to cause symptoms. Sometimes the treatments, or even the tests themselves, cause harm. In my own circle, for example, one woman recently developed renal failure attributed to ‘preventative’ medication prescribed on dubious grounds, and another suffered a bowel perforation during a ‘routine’ colonoscopy which had revealed no abnormality.

Many experts, quoting statistics from studies on large populations, claim that the benefits of screening tests and preventative interventions outweigh their risks. Others disagree. Political and financial factors are often involved as well as strictly medical ones. For example, the recent books Pharmageddon by David Healy and Bad Pharma by Ben Goldacre reveal the techniques through which drug companies covertly encourage doctors to prescribe. And although most healthcare professionals are sincerely motivated to put the good of their patients ahead of personal gain, they may be unconsciously influenced by the fact that careers can be advanced and money can be made by promoting screening programs or by broadening the definitions of pathology.

Over the years, I have been diagnosed with several different borderline conditions myself. I had treatment for some of them, and others I chose to ignore, but whether these were the ‘right’ decisions I may never know.

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