If you have diabetes, your doctor might just be over-treating you. According to a recent study in the medical journal BMJ, more than half of those with diabetes are getting way too many tests. And as we know, too many tests usually leads to too many—or too strong—medications.
The study looked at how often diabetics were given a hemoglobin A1C test. This is a test designed to look at how well your blood sugar has been controlled in the past three months. It’s intended to be done only once or possibly twice per year if your sugar is well-controlled. The study found that, far from once per year, a whopping 55% of people were tested three to four times. And 6% were tested five times or more.
But when did Big Medicine let a guideline stand in the way of profit?
More frequent testing isn’t just a hassle, or an extra expense. Like so many other “routine” tests, more frequent hemoglobin A1C tests are likely to uncover “problems” that aren’t really problems. More frequent testing means you’re more likely to be put on an additional medication that you don’t need, increasing the risk of dangerously low blood sugar.
Overtreatment is spreading like a virus
I’ve talked before about how many “routine” tests uncover “problems” that really aren’t problems at all. These “problems” can then be “treated,” but would often cause no harm if left alone. Not so long ago this was confined to tests for the biggies like cancer. However, it’s increasingly finding its way into everyday medicine.
There’s a movement to micromanage your health in every way possible—as long as it means taking another drug. We don’t just have diabetes and high blood pressure. Now we have “prediabetes” and “pre-high blood pressure” which are treated as aggressively as the real thing. And if you do have the real thing, the tendency to overtreat is even worse.
In the case of the A1C test, we’re talking about half of a percentage point. The talking point is that lowering you A1C from 8.5 to 7 may “modestly” reduce heart attack risk. What’s not a talking point is that the evidence suggests keeping blood sugar that tightly in check shortens lives. Or that older people run the risk of heart attack and stroke from severe blood sugar lows. That doesn’t sound like a good trade-off to me.
This is another case of “if a little is good, a lot must be better” thinking rampant in medicine. If one test is good, then three must be better. And five must be better yet. In this case—and in most cases—that’s simply not true. It’s a recipe for catastrophe, and it’s your health at stake.
Medicine’s Tower of Babel is part of the problem
It’s not just a matter of tests generating more money, although that’s certainly a factor in some cases. The unfortunate fact is that in medicine, all too often the left hand doesn’t know what the right is doing. It seems like none of us see just one doctor anymore. There’s one doctor for your everyday complaints, like a sore throat or a sinus infection. There’s another for your feet. There’s one for your heart, one for your stomach, and one for your shoulder you pulled a muscle in. The list goes on and on.
If you go to the hospital, the doctors there probably have no idea what your regular doctor has been doing. The heart doctor and the foot doctor don’t talk to each other. It’s enough to make you carry a copy of your medical records with you—if you can get your hands on them. But since most of us aren’t willing or able to do that, we’re left to deal with the fragmented state of healthcare all on our own.
That’s how some we end up with ten different prescriptions from five different doctors who may or may not know what the others have prescribed. It’s why we sometimes get treated for the same thing by multiple different doctors with different approaches. And it’s sometimes the reason we have the same test multiple times.
What can you do?
As with all things medical, the most important thing you can do is ask questions and be involved. Don’t sit back and assume that everyone involved in your medical life knows what the others are doing. And don’t assume that what’s being recommended is necessarily going to make a positive impact on your health. Be ready to ask the following questions:
- Why do you want me to have this test?
- Will it really improve my care or my health to have it?
- What will happen if I don’t?
- Why should I take this medication?
- How big of an effect will it have?
- What are the possible side effects?
- What’s likely to happen without it?
- Do the benefits outweigh the risks?
- Are there things I can do that aren’t drugs/tests/procedures that are effective?
Being informed is the first step to taking control of your health. Being proactive is the second. Questioning things isn’t just a smart thing to do — it’s vital.