Increase of Diagnosed Problems

But fibromyalgia wasn’t a recognized diagnosis 30 years ago. Nor were many other now-common diagnoses that have only recently been recognized and treated as medical conditions.

Since the 1980s, there’s been rapid expansion in the number and complexity of medical diagnoses — a trend known as “medicalization.” A recent study found that the cost of 12 newly medicalized conditions — things like irritable bowel syndrome, post-traumatic stress disorder, low testosterone, attention deficit hyperactivity disorder — now approaches $80 billion a year, or about 4 percent of total health care spending. That’s about as much as we spend on heart disease or cancer, and more than we spend on public health initiatives.
Our ever-expanding armamentarium of diagnoses no doubt offers comfort, attention and a path to treatment for many previously undiagnosed — and undiagnosable — patients. But we may also be medicalizing much of normal human behavior — labeling the healthy as diseased, and exposing them to undue risk of stigma, testing and treatment. ...
A central problem is that medicalized diagnoses often come with medicalized treatments.... Since the 1990s, the number of office visits for sleep problems has doubled, and diagnoses of insomnia have increased sevenfold. But prescriptions for sleep medications have increased more than 30 times.
This is perhaps most concerning for children. About 12 percent of children in America now carry a diagnosis of A.D.H.D, and there was a 40-fold increase in childhood bipolar disorder diagnoses between 1994 and 2003. Five times as many children are now prescribed psychostimulant and antipsychotic medications as were in the 1980s. Today, a quarter of children and teenagers take prescription drugs regularly.... ...
There’s no shortage of factors that have gotten us here. The pharmaceutical industry, for instance, has taken an active, sometimes dubious, role in defining and promoting new diagnoses, through direct-to-consumer advertising and physician outreach efforts.

Often overlooked, however, are how the psychologies of doctors and patients contribute. Clinical encounters that don’t end with a definitive diagnosis — a clear acknowledgment of the enemy — are inherently unsatisfying. ...
Many experts believe... that much of normal human behavior now falls within treatment thresholds.
- Dhruv Khullar, M.D., A Profusion of Diagnoses. That’s Good and Bad., NYT, Nov. 6, 2018

amyb, PA, 11/11/18
While I don't disagree with the overall premise of this piece, it is disheartening to see rising ADHD rates (and mental health diagnosis escalations) used as an example. These conditions are NOT medicalization of everyday challenges — they are real, profound difficulties that impeded children opportunities and paths to success. Most of all, they have evidence-based medical treatments. When a child can not see the blackboard, you don't make them sit 6 inches away — you give them glasses. Medication does the same for children with ADHD.

Additionally, a public health professional should understand that rising rates of disorders can be linked to other causes aside from societal changes. Recent research links shows nicotine can cause epigenetic changes that may lead to mental health and cognitive issues, such as ADHD. Consider that the current generation of ADHD children had grandparents in the nations largest generation of smokers.
- Comment in response to Dhruv Khullar, M.D., A Profusion of Diagnoses. That’s Good and Bad., NYT, Nov. 6, 2018

hen3ry, Westchester, NY, Nov. 6
A diagnosis can be an immense help when one has to explain to an employer, a co-worker, a teacher, a friend, or anyone else why one cannot do certain things. ...
What I've experienced is that people are forced to go and get a diagnosis because of our society's increased reliance on the rigid enforcement of rules when it makes no sense at all. With the exception of a few people, most will understand why the rules are being bent for one person. Those who don't or who object need to be reminded that they too will need rules bent for them one day.
DJS, New York, Nov. 9

Unfortunately, obtaining a diagnosis in order to obtain special privileges is being abused widely, in situations where there the individual does not suffer from the condition, but manages to pry a diagnosis out of a medical professional in order to gain special privileges.Specifically, a number of parents have convinced medical professionals to grant their children ADHD diagnoses in order to obtain extra time on exams such as college entrance exams. I know for a fact that this is done, as I know some of the parents and children who are involved. There is nothing wrong with these children. These parents want to give their children an edge over other children , and are harming the other healthy children who are not granted the additional time to complete college entrance exams, and other exams, given that these children are competing for entry at the same universities.
I could be wrong ,but it is hard to believe that there are so many children who suffer from ADHD, who are able to take AP classes ,gain admission to Ivy League Universities, and go on to earn doctorates, medical degrees and other advanced degrees.

''hen3ry, Westchester, NY, Nov. 9
@DJS, I know and I've seen it. Those parents make it much harder for people who are genuinely in need of the extra time or an accommodation.
- Comments in response to Dhruv Khullar, M.D., A Profusion of Diagnoses. That’s Good and Bad., NYT, Nov. 6, 2018

''fireweed, Eastsound, WA, Nov. 7
@Matilda Funny, when I got foster kids who had the diagnosis, most responded to routine and a lot of physical exercise before, during and after school. Suddenly the pills were no longer necessary. I agree that it is a legit diagnosis, but far, far too many foster kids are given the diagnosis because they won't "sit still and listen." I've also known of two cases where the mother taught her kids to act like they were ADHD, so they could get SSI---which she proceeded to live off of.
- Comment in response to Dhruv Khullar, M.D., A Profusion of Diagnoses. That’s Good and Bad., NYT, Nov. 6, 2018

Simply labeling people as diseased can make them feel anxious and vulnerable — a particular concern in children.

But the real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms. Sometimes the harms are known, but often the harms of new therapies take years to emerge — after many have been exposed. For the severely ill, these harms generally pale relative to the potential benefits. But for those experiencing mild symptoms, the harms become much more relevant. And for the many labeled as having predisease or as being “at risk” but destined to remain healthy, treatment can only cause harm.

The epidemic of diagnoses has many causes. More diagnoses mean more money for drug manufacturers, hospitals, physicians and disease advocacy groups. Researchers, and even the disease-based organization of the National Institutes of Health, secure their stature (and financing) by promoting the detection of “their” disease. Medico-legal concerns also drive the epidemic. While failing to make a diagnosis can result in lawsuits, there are no corresponding penalties for overdiagnosis. Thus, the path of least resistance for clinicians is to diagnose liberally — even when we wonder if doing so really helps our patients.
- H. GILBERT WELCH, LISA SCHWARTZ and STEVEN WOLOSHIN, What’s Making Us Sick Is an Epidemic of Diagnoses, NYT, JAN. 2, 2007

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