杏吧原创

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IF YOU have been to see a doctor recently, there鈥檚 a good chance that whatever your specific complaint, you also got a general check-up: BMI, blood pressure, cholesterol and a raft of other tests. For many people that ends with a prescription for a condition they didn鈥檛 know they had 鈥� perhaps a statin to lower cholesterol, or an ACE inhibitor for high blood pressure. Often, they will be taking those pills for the rest of their lives.

The lines between wellness and illness keep moving. Last year, for example, the UK鈥檚 National Institute for Health and Care Excellence changed the guidelines that suggest who should take statins to reduce the risk of a heart attack, widening the net to take in an extra 5 million people in England and Wales. For increasing numbers of people, breakfast is no longer just about food. It is also time to pop a pill or two, or three or even more (see 鈥�Everyday drugs: Are we taking too many preventive pills?鈥�).

Such measures seem like a good thing. Where鈥檚 the harm in catching potential problems early and using modern medicine to deal with them? We should tread carefully. A decade ago, another form of preventive medicine 鈥� routine screening for diseases, including some cancers 鈥� seemed a sure-fire route to saving lives. But overall, most mass screening programmes proved to be ineffectual or even harmful and were duly dropped; only a few remain. Over-screening is a real problem: false positives lead to unnecessary medical intervention and psychological trauma, while false negatives can lead people to ignore genuine symptoms.

The risks of prophylactic medication are different. We don鈥檛 know enough about the long-term effects of taking preventive drugs. And the ways in which multiple medicines interact is not well understood. As prophylactic prescriptions expand, public health bodies will have to decide if and when the benefits of adding more drugs to the mix are outweighed by the detriments.

Such decisions require long-term monitoring: the problems of screening should be a warning that large-scale preventive measures, no matter how well intended, can have unforeseen consequences.

We can be optimistic that these will be picked up. This week saw the launch in the UK of the , which aims to get doctors to stop 鈥渙vertreating鈥� patients for conditions such as mild depression or mildly elevated blood pressure. This has proven successful in the US, where doctors perhaps experience most pressure to 鈥渄o something鈥�, and adopted in countries including Australia, Germany, Italy, Japan, Switzerland and the Netherlands.

So medical bodies do seem to be acting as they should. But we should also be aware that medicalising people who might otherwise consider themselves healthy has the potential to take on a life of its own as part of a broader 鈥渨ellness鈥� movement. Again, this may seem a good thing. For many, wellness means positive lifestyle changes: a few well-chosen supplements, a healthier diet, regular exercise and cutting down on 鈥渟ins鈥� such as alcohol. Indeed, instilling such a mentality in the public at large may be the only way to tackle today鈥檚 healthcare challenges.

But there are many difficulties with the practice of wellness. We don鈥檛 yet have a robust system for distinguishing useful measures from useless ones. More and more activities are being sold as good for your well-being, from yoga to meditation to volunteering. Wellness risks becoming a treadmill you can鈥檛 get off: a never-ending guilt trip that you should be doing more. And a closer look reveals that some seemingly uplifting activities have a darker side (see 鈥�鈥淧anic, depression and stress: The case against meditation鈥�鈥�).

鈥淲ellness risks becoming a treadmill you can鈥檛 get off, a never-ending guilt trip that you could do more鈥�

The root of the problem is that we do not have a good scientific definition of wellness: it is no more than the absence of illness. But if wellness is now the goal of public health policy, as well as a personal quest for millions of people, it is high time to decide what we mean by it.

This article appeared in print under the headline 鈥淭oo much of a good thing?鈥�