Are we over-medicalized?

Reuters health editor Ivan Oransky warns that we’re suffering from an epidemic of preposterous preconditions -- pre-diabetes, pre-cancer, and many more. In this engaging talk from TEDMED he shows how health care can find a solution... by taking an important lesson from baseball.

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those of you who have seen the film
money ball

or read the book by michael lewis

will be similar with the story billy
bean

billy was supposed to be a tremendous
ballplayer all the scouts told them so

they told his parents that

they predicted that he was going to be a
star

what actually happened when he signed
the contract and by the way he didn't

want to sign a contract we want to go to
college

which is not my mother who actually does
love me

that i should do to you and i did

well he didn't do very well he struggled
mightily

he got traded a couple times she ended
up in the miners most of his career

and he actually ended up in management
ended up as a general manager of the

open dates

now for many of you in this room ending
up in management which is also what i've

done

is seen as a success

i can assure you that for a kid trying
to make it in the base

mad going into management and a success
story it's a failure

and what i want to talk to you that
today and and share with you is that our

health care system our medical system is
just a is bad at predicting

what happens to people in it patients
others

those scouts were at predicting what
would happen to billy being

everyday

thousands of people in this country

art diagnosed

preconditions

we share about tree hypertension we care
about tree dementia

we care about free anxiety and i'm
pretty sure that i'd agnes myself with

that in the green room

we also refer to subclinical conditions

there's subclinical atherosclerosis
subclinical hardening of the arteries

obviously linked to heart attacks
potentially

i'm one of my favorites is called
subclinical acne

if you look up subclinical acne you may
find a website which i did

which says that this is the easiest type
of acne to treat

don't have the post rules are the
redness inflammation

maybe that's because you don't actually
have acted

i haven't the name for all these
conditions it's another precondition

i call them preposterous

in baseball

the game

follows the pre-game

season

follows the preseason

with a lot of these conditions that
actually isn't the case releases in the

case all the time it's as if there's a
rain delay every single time in many

cases

we have pre-cancerous lesions

often don't turn into cancer

and yet

if you take for example subclinical
osteoporosis or bone thinning disease

the precondition

otherwise known as ours to kenya

you'd have to treat two hundred seventy
women for three years

notre prevent one broken bone

that's an awful lot of women

when you multiply by the number of women
who were diagnosed

with this esther pina

and so is it any wonder

given all the costs and the side effects

of the drugs that were using the treat
these preconditions that every year

we're spending more than two trillion
dollars on health care and yet one

hundred thousand people a year and
that's conservative estimate are dying

not because of the conditions they have

but because of the treatments or giving
them and the complications of those

treatments

we've medical as everything

in this country

uh... women in the audience site have
some

pretty bad news you already know

and that's that every aspect of your
life

has been medical hottest

strike one is when you hit puberty

you'd now have something that happens
you once a month that has been medical

institute condition

espy treats right too

is if you get pregnant

you half that's been medical arts as
well

you have to have a high tech experience

of pregnancy otherwise something might
go wrong

strike three

is menopause

we all know what happened when millions
of women were given hormone replacement

therapy

for work for it

menopausal symptoms

for decades until all the suddenly
realized because the state came at a big

one than h funded

it said

actually a lot of that commonplace in
therapy may be doing more harm than good

of those women

just in case

i don't want to leave the men out

i am one after all

i have really bad news for all of you in
this room

and for everyone

listening and watching elsewhere

you all have

a universally fatal condition

just take a moment

it's called pre death

every single one of you has it because
you have the risk factor for it

which is being a lot

but i have some good news for you
because

i'm a journalist elected and things and
happy where forward-thinking way

and that's good news is that if you can
survive to the end of my talk which

will see if that happens for everyone

you will be eight revive her

i made up three deaf

if i use someone else's freed up by
apologizing

i think i made it up

i didn't make a provider

provider is what a particular cancer
advocacy group would like everyone who

just has a risk factor

but hasn't actually had that cancer

to call themselves

your eight revival

is ready to be out here this morning
morning if mark burnett is anyone the

audience i'd like to suggest

nellie reality tv show called revival

if you develop the disease you're off
the island

the problem is we have a system

that is completely

basically promoted this

we've selected at every point in the
system

to do what we do and to give everyone a
precondition and then eventually

condition in some cases

start with the doctor patient
relationship doctors most of them

in a few for service system they're
basically incentivize to do more

procedures tests

prescribe medication

patients come to them

they want to do something where
americans we have to we can't just stand

there we have to do something and so
they want to be a drug

they wanted treatment they want to be
told this is what you have this is how

you treat it let's keep the doctor
doesn't give you that

you go somewhere else

that's not very good for doctors
business

or even worse

if you are diagnosis something
eventually and the a doctor didn't order

that test

you get sued

we have pharmaceutical companies are
costly trying to expand

the indications expand the number of
people who are eligible for a given

treatment

because that's the help survival
money-back disagreements

like the one that's come up with
provider

who want to make more and more people
fill their at her regrets or might have

a condition

so that they can raise more funds

and raise visibility

etcetera

this is an actually

despite what journalist typically do
this is not actually got blaming

particular players

we are all responsible

i'm responsible

i actually was for the yankees and talk
about

being sort of rooting for the worst
possible

offender when it comes to doing
everything you can do

everyone who's responsible uh... hai

you know went to medical school

and high was by didn't have a course
called had i think skeptically or

how not to order tests

we have this sort of system

where you know that's what you do

and actually took being a journalist

you know to understand all these
incentives you know economists like to

say

down a bit people

there are just banned sentence

and that's actually true

here's what we've created as a sort of
field of dreams when it comes to medical

technology

so when you put him another mri_ in
every corner you put the robot

in every hospital saying that there's
one has to have robotic surgery

well we've created system where if you
build it they will come

but

you can actually traverse lee

tell people become tell convince them

that they have to come

it was when i became a journalist and i
really realized how i was part of this

problem

and how we all or part of this problem

i was medical ising every risk factor as
writing stories commissioning stories

everyday

trying to sort of

but mr lim people worried though that
was what often happens

you know there are ways out

i someone internist last week

and

he said to me

you know and he told me something that

everyone in this audience could have
told me for free

but i paid him for the privilege which
is that

i need to lose some weight

well he's right i've had
honest-to-goodness high blood pressure

for a dozen years now stand

age my father got it

and it's a real disease it's not pre
hypertension is actual

hypertension high blood pressure

well he's right

and that's but he didn't say to me

well you have pre-opening city or

you have pre diabetes or anything like
that he didn't say

better start taking this step mid to
lower your cholesterol

they always have gotten some way come
back and sing in a bit

we're just in a common higher doing

so that's to me

you know away for work

billy being by the way when the same
thing

he learned

from watching this kid in the event
rehired who's really successful form

it wasn't swing for the fences that
wasn't sweeney at every pitch

like the sluggers do which is what all
the expense of teams like the yankees

like to

they like to pick up those guys

this kid solvent you know you gotta
watch the guys in depth go out and find

the guys who like to walk

is getting on this by a walk

is just as good and in our health care
system

we need to figure out

is that really good pitch

or should we let it go by and not swing
everything