Predisease. Otherwise Known as "Health" 
(December 12, 2017)

Predisease” is an actual word. It is a new term that I am certain was made up by some young marketing genius in order to scare people and sell them stuff. For that reason alone I very much dislike it, and I hope that it does not catch on. If it does, though, you will have been forewarned.

The word is being used to imply an early disease state, as for example in 'prediabetes'. And I say “imply” instead of “describe” for a reason. If you describe something, you are just trying to communicate its characteristics. If you imply something, you are cravenly trying to create an impression in the mind of your victim without having the guts or integrity to say what you actually mean. Telling someone they have a disease when they don’t is just plain dishonest, because that is what this term is doing.

See, when you say “pre disease”, people just hear the word root ‘disease’ in there. That makes people think “OMG, I’m sick, I’ve got to do something dramatic”. This is one thing if you have a pre-cancerous lesion on your face. It is something else entirely if you have blood pressure of 120/80 and are being told that you have “pre-hypertension”.

How you think about an issue has everything to do with how you choose to deal with it. If you hear “disease” your mind will toss the "pre" to one side and almost certainly race forward to hoping that you can be fixed with drugs and surgery. And depending upon which predisease is being talked about, that very likely is the wrong thing to do.

Here is an example. In days of yore, blood pressure wasn’t considered to be worth lowering until it was 210/100 or so. As we’ve achieved more knowledge and produced better treatments over the years, that number has inched down until it is currently 130/80. The reason this transformation took place is that we acquired EVIDENCE that treating blood pressure at lower and lower numbers had a nice payoff for the patient in terms of decreased heart disease with risk of few side effects. But if you do these same treatments on someone whose blood pressure is not yet high, not only are you not improving their health but your treatment is running the risk of actually injuring them by producing unnecessary side effects.

Conventional medical treatment carries a lot of risk, so this tension between treatment and no-treatment is present in most conditions.  And the problem is that if you start calling things “pre diseases” you are encouraging doctors and lay people alike to use medical treatments in circumstances where, like I described above, there is at best no benefit and at worst considerable detriment.

So if you’ve got some funky numbers that your doctor wants to call predisease, you must first Not Panic. You must then ask a few questions and determine 1) what happens if you do nothing about this, 2) what will NOT happen if you DO something about it, 3) what can be done about it (medically), and 4) what ELSE can be done about it (lifestyle-wiise).

If there isn’t a simple effective medical solution for the issue, you'll be addressing it with lifestyle. In the case of prediabetes, for example, you can watch your carbs and diet and start exercising instead of leaping right for the metformin. 

Changing your lifestyle for the better will never get you in trouble. Using a conventional medical treatment very well may. 

Medical interventions have side effects.  Sometimes they are negligible and/or rare. But that is not true of medications. 15,000 people a year die from aspirin and similar NSAIDs, for pete’s sake. Taking prescribed medications is the fourth leading cause of death in the U.S., and many of those were taken as directed. So you really don’t want to jump into that pool unnecessarily.

It’s ironic. For many decades conventional medicine was telling people that if they weren’t actually ill, they were healthy. Of course anyone who ever had a hangover knew that that was just so much nonsense. Yet that was what your Doctor would tell you, and you knew who HE was. Now the business of medicine is taking the opposite tack of trying to make everyone who isn’t a shining youthful picture of health, sick.

Do not buy into that. If you don’t have a problem that is well characterized and has a solid treatment, go for improving your diet, exercise, sleep, stress, etc. Health and wellness come from lifestyle, not from medicine. Medicine is for when you are sick, not for when you are pre-sick. Whatever THAT is. 

--dr. diane holmes
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