Blog entry by Meguid El Nahas

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by Meguid El Nahas - Wednesday, 10 July 2013, 12:33 PM
Anyone in the world

Excellent Editorial in the BMJ entitled: Too much Medicine; Too Little Care:

This Editorial makes excellent points about:

1. Redefining diseases such as Hypertension, Diabetes, obesity, hypercholesterolemia, osteoporosis and... CKD as to increase their prevalence...and raise the spectrum of "Epidemics"...!!! More an Epidemic in Diagnosis rather than a true Epidemic of Disease!

2. Redefining thresholds for disease definition leading to medicalisation of normal variations "normality"..."ageing"...etc...

3. Overinvestigating and consequently Overdiagnose; mostly incidentalomas....

4. The above raising concern, anxiety, cost...with little impact on Outcomes.

This Editorial suggests:

1. More Scepticisms from Physicians about changing thresholds.

2. More Scepticism amongts physicians about new definitions of disease

3. More Scepticism about new Guidelines and Recommendations

4. Better use to language and semantics of health and disease:

Use the terms “raised blood pressure” not “hypertension,” 

“reduced bone thickness” not “osteoporosis,”

“reduced kidney function” not “chronic kidney disease” when talking with patients.

5. Better sharing with the Public of the uncertainty and significance of the findings as well as the risk, benefits and cost of screening and redefining   diseases.
This applies to CKD as much as any other "disease", with clear healthcare implications including an increasing overlooking of true CKD (that is referred CKD of patients with glomerulonephritis, vasculitis, interstitial nephropathies, heriditary diseases etc...) whilst more attention and probably manpower and resources are diverted to:
1. Looking/Screening for "CKD" in has become an our profession!?
2. Early detection of CKD...with little insights into potential harm...and known benefit...?!
3. The growing "Epidemic" of CKD... which seems related to an "Epidemic" of Diagnosis and eGFR formulas rather than a true change in the number of people with progressive CKD or ESRD; the latter if anything may be coming down rather than increasing!
4. The Medicalisation of Normality; decline of kidney function with age...?!
We have to ask ourselves:
WHO has a vested interest in such "Epidemic of CKD"
The answer seems manifold:
The Profession: Increasing its profile; from a small subspecialty of Medicine to a Global Healthcare Challenge!
Nephrologists: More Research into a new disease, a growing disease, a major threat...more grants, larger departments, more income generation...more publications, etc...Academic Recognition?!
Market factors: More disease, More Patients, More Consultations, More Income...?!
Pharma: More Disease, More Patients, More Treatments, More Income...?!
All very intriguing but happening in CKD, which would be acceptable if HARMLESS, but of considerable of concern if HARMFUL!
[ Modified: Thursday, 1 January 1970, 1:00 AM ]