Posted by: drwbortz | May 11, 2010

The Epidemic of Pre-Disease

Now we have pre-cancer, pre-hypertension, pre-dementia, and particularly pre-diabetes.

When I was in medical school, 50 years ago, we were taught that diabetes was a disease caused by lack of insulin, resulting in high levels of blood sugar, and the diagnostic symptoms of excessive thirst and hunger and weight loss. Then, enterprising physicians seeking more rigor in making the diagnosis proposed that the disease of diabetes could be confirmed when the first morning blood level was over 125 mg/dl.

This diagnostic label was widely encoded, but more recently became amplified by the addition of the term pre-diabetes, which is employed when the morning sugar level was not yet 125 (mg) but was over 100. So pre-diabetes screening was proposed to identify those unsuspecting persons whose borderline test results predicted that, although they didn’t officially have diabetes, they were at increased risk of developing it.

I have personally contributed to this practice by proposing the term pre-pre-diabetes in my book “Diabetes Danger”, suggesting that those 200 million Americans who were unfit and overweight are in the progressive pipeline leading to diabetes, but are not as yet officially coded in standard nomenclature.

Such pre-disease linguistic devices are intended to alert persons with no actual symptoms, but who are securely headed in the direction of the full blown disease, that something is amiss. This early knowledge is like a blinking red warning light.

Yet in my view, the proposition of early detection has been substantially subverted by the pharmaceutical industry, which floods our channels with their promotional tidbits. “Maybe you don’t have X or Y or Z , but we encourage you to consult your physician so that he or she can prescribe our trusty medicine to manage your pre-disease.” Aligned with this practice is that of the tech-testing folks encouraging tests, MRIs, scans, blood tests, etc. to see whether you quietly are really at risk of a pre-sickness. Dr. Clifton Meador wrote an article in the “New England Journal of Medicine” 16 years ago in which he explored the phenomenon of “the last well person” for whom voluminous testing only showed that everything was perfect, whereas the rest of us all have some trigger to alert that something may be wrong or going to be wrong. This concept then reveals that the rest of the 300 million of us are sick or pre-sick. And we better get our act together to find out what’s wrong quickly.

Eminent psychiatrist, Dr. Thomas Szasz has published a collection of essays under the term the “Medicalization of Everyday Life” in which he details the application of medical diagnostic labels to everyday occurrences. A freckle becomes the dermatologist’s good friend. The tension headache prompts a head scan, $1,000 work-up. A skipped heart beat demands a Holter monitor and a cardiologist.

The medicalization of America, in which every citizen has been converted into a patient, has been widely identified as one of the major escalators of health-care costs. Repair is the leit motif of the medical system. This presumes that our medicine’s diagnostic competence to reach out to what might be repaired through drugs and surgery is so compelling that we have a responsibility to attend to the freckles, heart skips and stresses ASAP. As the medical-screening door swings open to invite everyone in, a crowd develops, and expenses soar. But what if we are all at risk, as in my pre-pre-diabetes category? You can’t propose tracking and treating all of us for a disease that hasn’t yet happened, or can you?

As an alternative, I propose the proposition of prevention. What if all the preconditions listed above could be averted reliably, safely and cheaply with simple self-care, which doesn’t require any tests or therapies to guide the effort?

In my view, this is precisely what we must have, if we are not get healthier before we bankrupt the health care system. With the appropriate non-medicalized counter-strategies, instead of pills, scalpels, MRIs and statins, I suggest to Washington that we must establish a health lobby to offset the sickness lobby. We need physical exercise, a reasonable diet, parks and trails, and ways to alleviate stress.

What if these non-drug therapies are safer, more effective, and are more appropriate to our health needs than the medicalizing sirens that are abusing us by their alarm tactics?

Anybody up for such an idea?



  1. Where have you been Voice of Wisdom? You speak my language. I am in a real struggle with prediabetes and am working very hard with a private practice dietition my doctor referred me to. I need your voice. I need to hear all you have to say about preventive care, and especially prediabetes. Today I am starting a blog of my journey with prediabetes. I hope it will be an accountability tool for me. “My Journey With Prediabetes” at

  2. Thanks. Please see my book “Diabetes Danger.”
    Prediabetes is mostly a bogey-man encouraging us to do what we should be doing without the medical mumbo-jumbo.

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