Someone mentioned to me the other day that her doctor had diagnosed her with “borderline prediabetes” and recommended medication. I’m rather aghast.
This is part of a disturbing trend in medicine to pathologize normal. The “logic” goes something like “if we diagnose someone with a disease when they don’t actually have it, maybe it can help them avoid getting it.” Wow. I’ve found that — for life in general — lying to people to get them to do what you think they ought to do rarely works out well. When the person doing the lying is supposed to be a trusted professional, then they just succeed in destroying trust. Trust is an important commodity in a therapeutic relationship and must not be squandered.
Just for background, “prediabetes” is a construct wherein you label someone with perfectly normal blood sugar and metabolism as being sick in the hope that they will then, possibly, make lifestyle modifications and/or take medication in order to keep from becoming sick. It’s silly on its face: we don’t tell women of childbearing age that they’re “pre-pregnant” even though they might well be candidates for contraception or abstinence. We don’t tell people with a BMI of 24 that they’re “pre-obese.” And even if you think it’s okay to lie to someone if it “serves a greater good,” remember that there are real-world, practical consequences to labeling someone as diseased — not the least of which is that you might have just made it more expensive or impossible for them to get health insurance.
But this person didn’t even have what a lying endocrinologist might call the disease of “prediabetes,” she had “borderline prediabetes.” She had perfectly normal blood glucose markers but they were close to (but not exceeding!) the threshold at which we call perfectly normal people “prediabetics.” What’s next? “High normal borderline prediabetes?” “Trending toward someday possibly having borderline prediabetes?” “Potential borderline prediabetes?”
If we’re going to embrace a disease model (there are good arguments against it, but that’s the model engrained in western medicine), then we really need to resist the urge to label everything normal as “sick.”
—2p