Too Much Medicine? Not Necessarily

by JHI Staff on July 14, 2014

A recent journal article examined the issue of “overmedicalizing,” or handling a normal human condition as if it were a disorder requiring medical treatment. Claims of overmedicalization have been made about several conditions. For example, attention deficit hyperactivity disorder (ADHD) may be a brain condition treatable with medications and therapy—or a label wrongly attached to a normal set of cognitive and personality traits. Aging and death are natural processes that call for little or no medical intervention—or ones that can be staved off or mitigated by treatment.

Some claims can seem reasonable and should give us pause, for example, people very near the end of their lives receiving aggressive treatment rather than palliative care. In other cases, we should be wary of the claim, because treatment can truly lengthen life span and raise the quality of life. As an example, consider the fact that through the 1980s and beyond, some loud voices insisted that AIDS was a syndrome caused by drug abuse, and not a viral condition that might be treatable.

Clearly this issue can be complex. Consider the role of culture in whether a situation might urgently call for medical intervention. In the U.S., for example, many would agree that a cancer drug capable of adding six months or so of high-quality life to a patient’s prognosis ought to be an essential treatment. But some Johns Hopkins Medicine oncology faculty who have spent time practicing at Johns Hopkins Singapore have been surprised to find that not all patients there feel the same. What is considered good medicine here in the U.S. might be considered overmedicalization in other cultures. We’ve learned to respect these sorts of differences, which we encounter all over the world.

People tend to speak of health care as if it necessarily looks at all patients’ problems as being candidates for medical treatments. Historically, that’s probably a fair claim—health care systems have indeed been biased toward treatment, and usually in hospitals and doctors’ offices. But that’s changing, and quickly. Increasingly, health care is spreading out from the hospital to the community and even the home, reaching people not just with medication and procedures but also with education and support services that promote healthier lifestyles and prevention. Health care wants to do more to keep patients from needing to be in hospital beds, or from even requiring any treatment or special care at all.

As that transformation to “the bedless hospital” continues, and medicine becomes as likely to provide emotional support, dietary advice and healthy-habit coaching as it does medication, concerns about overmedicalization will become less urgent. The question won’t be whether medicine should be involved in a problem, but rather what flavor of medicine should be involved.

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