MANY people are aware of the saying ‘prevention is better than cure’; it’s therefore logical that if you cannot prevent, you should seek to detect early and try to cure. If you detect late, then it might already be too late to bring about a cure.

This aphorism applies to many diseases, particularly those that carry possible devastating outcomes such as cancer, or those causing end-organ damage such as heart, liver, and kidney failure, or damage to one’s eyesight or brain. We stand a chance of catching things early by doing regular check-ups, where the doctor does a thorough examination and appropriate investigations. Research has shown that early detection improves the outcome of the disease when treatment is started early.

DENIAL

However, because many people feel no symptoms, some illnesses like cancer do not cause any ill feelings at the onset, they may feel they are well and not in need of an annual check-up. According to Geoffrey Frankson, health promotion specialist, “Your pressure could be sky-high and your coronary arteries 80 per cent blocked and yet you feel no symptoms at all; your kidneys could be functioning at 50 per cent, your liver 60 per cent destroyed by alcohol-induced cirrhosis, and you would still feel okay.”

When catastrophe occurs however, you rapidly go downhill and the hands of time cannot be turned back. Then you say: “If only!” Well, you should remember ‘prevention is better than cure’.

MENTAL HEALTH

At the other end of the spectrum, a recent article in the British Medical Journal reported that ‘disease-labelling’ may cause problems by altering a person’s perception of their own well-being. The authors, who were public health researchers at the Norwegian University of Science and Technology, wrote that increasingly more persons are being labelled due to more health programmes being done, more screening for various diseases, and the establishment of lower thresholds for diagnosing some diseases.

The main concern is that increasing attention is being placed on the matter of over-diagnosis, where people are labelled with a disease, but where treatment does not necessarily lower the death rate. Over-diagnosis refers to diagnosing and treating early or minor conditions that may never progress to cause any major problem. This can include the controversial practice of diagnosing ‘pre-disease’ states such as elevated blood sugar that falls short of diabetes.

BENEFIT VS HARM

The crucial issue is whether discovering a disease will lead to treatment that can lower the death rate. If there is no benefit to improved quality of life or longevity, then such knowledge may possibly do more harm than good. The personality type of the particular person is important as some people are natural ‘worriers’ or hypochondriacs, while some are better able to tolerate bad news.

Not surprisingly, the researchers found that persons with a diagnosed illness were less likely to say they were in good health. Conversely, people with undiagnosed severe high blood pressure were more likely to report good health compared to persons with normal blood pressure readings. Many people with disease but without knowledge of this fact reported their self-health as good, even more than healthy persons.

The authors proffered that people who don’t know about their conditions are more optimistic and generally worry less, so they are less likely to visit doctors for check-ups or when they have vague symptoms. But therein lies the problem.

THE CRITICAL QUESTIONS

Consequently, the authors say people should be concerned and ask critical questions like whether health screening will do them any good or improve their chances of living longer. It would be unfortunate if doing more check-ups caused more people to be defined as sick and so undergo treatment without any reduction in morbidity or mortality. While many think early detection can only be good, the flip side is that giving someone a diagnosis or label may also be harmful to their mental health.

THE AIM: EARLY DETECTION

So while genuine illness should be treated, we should also think deeply on these matters to avoid unnecessary labelling while having a more positive attitude about the early detection of some of the diseases. It is always better that a patient and his or her doctor know about any health problems so they can work through them. If someone has mild diabetes or the metabolic syndrome, which is a triad of diabetes, hypertension and high cholesterol, it is always better to work to get that person to a near-normal state. The health outcome matters.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is a member of the Executive Council of RedBioetica UNESCO.