Pre-Osteoarthritis: Do we really need another "Pre-" disease?

This Spring, Dr Annemarie Jutel (RN, BPhEd(hons), PhD) from the Victoria University of Wellington shared with m some of her work on Social Issues in Diagnosis.

Dr Jutel is a social theorist and clinician interested in finding an understanding of just how diagnosis works, whether from the historical, linguistic, social, literary, clinical, or other angle. 

She explained: 

I am most interested in the “diagnostic moment” and the power of the diagnostic utterance; there is nothing that fundamentally changes in your soma from the moment you walk in to the doctor’s rooms, and the moment you get your diagnosis, but at the same time, if the diagnosis is a difficult one, everything has changed. 

I started following her posts on the Facebook Group, Social Issues in Diagnosis, which explores why and how we create these labels and what impact they have on patients and the course of medicine.

The most recent post is about pre-diagnosis, stimulated by this 2015 paper in Cartilage. If we can detect osteoarthritis before it starts, maybe we can stem the epidemic. Or, maybe we can turn a bunch of healthy, naturally aging, well-people into frightened patients?

In response to the article, Jutel asks:

What is a prediagnosis and what are its consequences? 

If pre-diagnosis states are, potentially, windows of opportunity, wherein individuals can adopt healthy, disease-avoidance behaviours, is there an advantage to calling these states "pre-whatever" as opposed to identifying them as healthy states, wherein health can be further improved?

What are the consequences of being given a pre-diagnosis? For some it may be a scary moment which marks their identity forever more. For others, it may be a wake-up call.

What would it be for you?

Take a look on the FB Group to participate or to learn more, see her book, Social Issues in Diagnosis.

Source: http://www.ncbi.nlm.nih.gov/m/pubmed/26175...

Doctors warned not to encourage young women to freeze their eggs

Aging is a normal part of human existence.

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As we age, parts of our body change the way in which they work - or stop functioning all together. For women, natural aging means a slow down and then a stoppage in our ability to be fertile.

With women increasingly devoting the early part of their lives to establishing a career, many are delaying pregnancy. Some are freezing their eggs for later use. Physicians, employers, and society as a whole are starting to encourage this practice.

This is troubling in a few ways. Drs Petropanagos and colleagues write (in the CMAJ) that it raises some significant social implications, reinforcing that "motherhood is a central aspect of womanhood." 

Egg freezing as a way of preserving women’s reproductive options reinforces the social norms and expectations that construe motherhood as a central aspect of womanhood. Women are encouraged to freeze their eggs as a way to “have it all” (that is, to have both a family and a career), implying that for those women who want both these things, egg freezing makes this possible. Although individual women may benefit from egg freezing to satisfy their reproductive desires, physicians should not assume that having a genetically related child is equally important to all women who ask about social egg freezing.

Our bodies do things for a reason. Delaying pregnancy and then using frozen eggs exposes women (and their new children) to greater and greater risks, due to complications of pregnancy and childbirth. 

Fighting the natural changes makes aging a 'medical problem' rather than a part of our existence that we can embrace and accept. I agree with the authors' suggestion that there are better solutions, like funded child-care, that could enable women to really have a choice when it comes to balancing motherhood and a career.

Read the National post article here, or the original CMAJ article here.

Source: http://news.nationalpost.com/health/doctor...

"#Overdiganosis is in the eye of the beholder" The challenge begins with definition

Stacy Carter headed a great session at the Preventing Overdiagnosis 2014 conference in Oxford, which is where I met her for the first time.

 This BMJ talk Medicine interview expands on that session and on the paper written with Rogers, Heath, Degeling, Doust, and Barratt. They explore the culture (ethical and social aspects) and science behind "overdiagnosis," why it is so hard to define, and limitations of the term.

Listen at the BMJ and read the paper, which I am delighted to report, cites this website!

Source: http://www.bmj.com/content/350/bmj.h869