Based on a large population survey in Norway, the authors say that
increased use of screenings, more sensitive tests and widening
diagnostic criteria may cause unexpected harm because poor
self-rated health is tied to a greater risk of death.
Although early detection of disease can be important for treatment,
the authors write in the journal BMJ Open, “disease-labeling” may
cause problems by altering a person’s perception of their own
“We know ever more people are being labeled, owing to more
screening, lower diagnostic thresholds, commercial - and
non-commercial – health campaigns and so on,” Pal Jorgensen said.
“Self-rated health is shown, several times, to be inversely
associated with mortality.”
Jorgensen, who led the new study, is a public health researcher at
the Norwegian University of Science and Technology in Trondheim.
“It is also an important aspect in the increasing attention and
discussion of overdiagnosis; people being labeled with disease, but
where treatment does not lower mortality,” Jorgensen told Reuters
Health in an email.
Overdiagnosis generally refers to diagnosing and treating early or
minor conditions that may never have progressed to cause a problem.
This can include the controversial practice of diagnosing
“pre-disease” states, such as slightly elevated blood sugar that
falls short of diabetes (see Reuters Health story of May 6, 2011,
To gauge the effect of being diagnosed with disease on a person’s
perception of their own health, Jorgensen and his colleagues
analyzed data on 33,734 adults between the ages of 40 and 70 who
were surveyed and medically tested in the mid-1990s in Norway.
The researchers were interested in connections between how the
participants answered the simple question “How is your health at the
moment?” and whether or not they were aware of having specific
health conditions, including diabetes, thyroid disease and high
The researchers used the medical testing data to determine if people
actually had any of those three conditions, and found that people
with diagnosed illness were less likely to say they were in good
But people with undiagnosed illnesses were more likely to say their
health was good than people without those illnesses.
For instance, women who knew they had hypothyroidism were less
likely to report good health than women without thyroid disease, but
women who didn’t know they had thyroid problems were 84 percent more
likely to believe they were healthy than women who didn’t have
Similarly, people with undiagnosed severe hypertension were more
likely to report good health compared to participants with normal
blood pressure readings.
And, in general, participants who didn’t know they had diabetes or
mild to moderate hypertension were just as likely as people without
the disorders to believe they were in good health.
“We were surprised that many persons with disease, without knowledge
about this fact, reported their self-rated health as good, sometimes
even more often than healthy people,” Jorgensen said. “The fact that
persons with acknowledged disease report their health as poor was
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It’s important to note that the study relied on self-reported
information, which may not be completely accurate, and that studies
like this can’t prove that knowing about a health condition actually
causes a person to feel they’re in poor health, the authors caution.
It’s possible that people who don’t know about their conditions are
more optimistic and worry less in general so they’re just less
likely to go to the doctor for check-ups or when they have vague
symptoms, Jorgensen and his colleagues write.
Jorgensen said that people should be concerned and ask critical
questions, like whether health screening will do them any good or
improve their chances to live longer.
“The main effects of check-ups are more people defined as sick, more
people undergoing treatment, without lowered mortality,” he added.
Dr. Otis Brawley, chief medical officer of the American Cancer
Society and author of "How We Do Harm: A Doctor Breaks Ranks About
Being Sick in America,” told Reuters Health the researchers are
right on target.
“We've got data to show that depression and suicide increases in men
who are known to have an elevated PSA, not men who have prostate
cancer but men who have an elevated PSA that merits an evaluation
for prostate cancer,” he said.
People think early detection can only be good and they don’t know
that giving someone a diagnosis or label can be harmful, he said.
“So I think we need to think about these things, but we also need to
have a more positive attitude about the early detection of some of
these diseases,” he said.
Neither expert suggested that genuine illness should go untreated.
Brawley said he would prefer that a patient and doctor know about
any health problems so they could work through them.
“If I’ve got someone who's got mild diabetes or metabolic syndrome I
might actually be able to work with that patient and actually get
them to a near-normal state,” he said.
BMJ Open, online May 28, 2014.
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