Too often, doctors pursue ‘normal’ numbers instead of looking closely at the patient
“Once we base our definition of disease on numerical abnormalities, we can change the numbers in a way that expands those who have the disease. This has been occurring in dramatic fashion the past 20 years, especially since Medicare (by congressional decree) relinquished the task of defining normal numbers to specialty medical societies. Hence the American College of Cardiology can change the definition of an abnormal cholesterol reading or abnormal blood pressure reading such that more people will be labeled with a diagnosed disease related to these numbers. Likewise, the American Society of Nephrology can broaden the definition of what constitutes abnormal kidney function and expand the scope of those now diagnosed with kidney disease. The list goes on and on, from diabetes to dementia to skin cancer; the criteria for being declared sick is rapidly being broadened, instigating epidemics of diseases across the medical horizon.
These fabricated crises affect well more than half the population and drive a measure-diagnose-treat crusade to eradicate sickness by prescribing medicines, ordering tests, seeing specialists, and undergoing procedures, all in an effort to normalize errant numbers. We are squandering trillions of dollars, often to the detriment of our patients, merely to push a number across some arbitrary line of what we call “normal.”
Without a doubt, treating high blood pressure and high sugars in a measured and patient-centric way has saved hundreds of thousands of lives. Helping high-risk people with osteoporosis can similarly improve the lives of people we treat intelligently.
But when our zeal to fix all numbers transcends the science, when all patients are viewed similarly regardless of their individual risks, when numbers eclipse the meaningful health of those we are treating, and when what constitutes a “normal” value is constantly altered to make more people appear sick, we have all the makings of a Flexnerian epidemic, named for Abraham Flexner, whose 1911 Flexner Report set the standard for American medicine.
When Flexner and his colleagues insisted on reconstructing health care upon a bedrock of science, they assumed that if you can test someone and determine what is physiologically aberrant in his or her body, you can address that abnormality and perhaps fix it. Science, to the architects of the Flexner Report, is not fickle or subjective; it is measurable and absolute.
But they ignored the malleability of scientific “facts.” Studies can be designed to reach foregone conclusions. Cognitive biases can distort our views of what is medically relevant. Benefits of certain interventions to fix abnormalities can be exaggerated and risks minimized. And the very term “abnormal” is hardly objective since it has to be defined by someone. [..]
SPRINT looked at a few thousand highly screened people, all of whom had severe heart disease [..]. It found that by adding an extra medicine to those with blood pressures over 140 systolic, and getting that pressure below 120, there was substantial improvement in outcome. But what does a 25% relative reduction in heart attack and a 40% relative reduction in death actually mean? How many people actually benefited from aggressive blood pressure lowering in this very select group?
It turns out, not many: One out of 1,000 people treated aggressively avoided a heart attack or stroke, and two out of 1,000 lived longer by pushing pressures below 120 systolic. But we don’t know how much longer they lived. Not only does the study fail to reveal that fact, it also doesn’t tell us if people live longer because of lower pressure or from some other benefit the add-on medicines might confer in regard to their underlying severe heart disease.”
Full editorial, A Lazris and A Roth (authors of “A Return to Healing”), STAT, 2025.5.29