Risk factors

“I am going to prove, that you all are dead”.
Juan Gervas (famous doctor and author) once put it in a presentation. He was talking about a new guideline for heart failure. It defines four stages of heart failure. Stage A is for people without structural heart disease or symptoms of heart failure, but who are “at risk” for it. At the end he came back to his statement from the beginning: “Now you can see that you are all dead – but fortunately only stage A!”

There is a lot of truth in this joking. Is it really the worry for people that drive them to doctors? Or is it the sarcastic broadening of the narrow spectrum of patients by doctors who are more and more specialized and by this rising specialization have less and less patients? Or is it the seemingly moral free activity of pharmaceutical companies in search of new consumers for their products? Probably it is neither only this, nor only that. It is a danger we are all in. This is what we should keep in mind while thinking on the risks of being ill or having any major chronic illness. While the patient experiences illness and deserves a disease label, doctors, as newly proposed, would label a majority of these illnesses as MUS (medically unexplained symptoms).

All these symptoms and illnesses widely open up the doors for endless diagnostic procedures. Most of them will have normal results, but many will have borderline or false positive results. The consequences are endless further diagnostic tests and prescriptions of never proven therapies with well-known side-effects.

Much has been learned about the importance of risk factors being relative. Say for an example, the majority of men over 80 will have prostate cancer. Only few of them will die from it.

In fact the media, the pharmaceutical industry, politicians and the medical professions in a weird mixture of best intentions and economic profit have the potential to create doubt and worries about even the most robust health of the people. Moreover, after some age people start saying, “You know, I was always in good health but I feel I am coming to a certain age now and my wife said that I should start to do something to stay healthy”. The human mind seems to be more open to action, even if it turns out to be useless or even harmful, than to no action or a ‘wait and see’ approach. This can turn into absurdities such as women continuing to have Pap-smears in 69% of cases after having had a complete hysterectomy (removal of uterus) in the US.

The feeling of being ill does not necessarily meet the doctor’s judgment that there is a disease present. To understand the risk factors is quite essential. At the same time, it is highly recommended to evaluate its relative value in your case.