What Does It Mean To Be "Healthy"?

My brother-in-law, who is an emergency-room physician, used to joke that the definition of someone who's healthy is "someone who hasn't been tested enough."

I used to think that was funny, but I'm not so sure now.

Today's New York Times carries an essay and a book review -- side-by-side in the print edition, no less -- that raises questions about the ways we have been redefining "healthy".

In a review of a new book by Susan Cohen and Christine Cosgrove titled, "Normal at any Cost", Dr. Abigail Zuger considers the medical industry's use of assorted hormones to make sure that girls weren't "too tall" or that boys weren't "too small". Headlined "At What Height, Happiness", Zuger notes that once human growth hormone could be synthesized, important new ethical questions arose: "Psychologically, will children be helped more by the possibility of extra inches than they are hurt by the implication that they are defective, disappointments to their parents for failing to 'perform biologically'? Is deciding against growth hormone for a child like deciding against a nose job, or is it like deciding against eyeglasses?"

The essay, "To Overhaul the System, 'Health' Needs Redefining", by Dr. H. Gilbert Welch, analyzes the re-definement of "health". It is no longer the absence of sickness, but "the absence of abnormality". In order to keep business growing, the medical industry has resorted to two clever techniques: (1) designing ever more skillful diagnostic tools to find ever smaller abnormalities, and (2) narrowing the definition of normal (here, Dr. Welch uses the example of "high" blood pressure, from which, in the past, relatively few adults were thought to suffer; by redefining the "norm", well over half of adult Americans are now "sufferers".)

Dr. Welch notes that "absence of abnormality" fails as a definition for health because it "is both too narrow and too broad. It's too narrow because there's more to being healthy than striving to avoid death and disease. Health is ... also a state of mind. And it's too broad because all of us harbor abnormalities... We then feel more vulnerable. This induced vulnerability undermines the very sense of well-being and resilience that in many ways defines health itself."

The behaviors of individual physicians and researchers who develop the new tools or drugs may or may not be ethical -- I'm not about to make sweeping generalizations here.

But overall, I am willing to say that I consider the actions of the medical-pharmaceutical industry unethical. Both Drs. Zuger and Welch point to serious problems. A third is direct-to-the-patient advertising, which I have always opposed (and for the longest time, I have been a lone voice in a very big wilderness). Finally, a few others have joined me out here.

Yesterday's Times, in fact, carried an article by Natasha Singer about the lawmakers who are finally starting to worry about the risks of these advertisements (as opposed to extolling the virtues of a "more educated" consumer).

My favorite quote was from Rep. Jerrold Nadler (D-NY) who is sponsoring a bill that would amend the tax code to prevent pharmaceutical companies from deducting the cost of direct-to-consumer advertisements as a business expense:

“You should not be going to a doctor saying, ‘I have restless leg syndrome’ — whatever the hell that is — or going to a doctor saying, ‘I have the mumps,’ ” Mr. Nadler said in an interview. “You should not be diagnosed by some pitchman on TV who doesn’t know you whatsoever.”

When I'm sick -- which means "not healthy"! -- I should see a doctor, explain my symptoms, answer any questions she might have, and let her figure out what course of treatment to recommend to me. And if it means that you don't have to watch ads that cause your six-year-old to pipe up with questions like "what's a four-hour erection?", so much the better....