As Medicine Gets Better at Detecting Risk, Will We All Become Patients?

After a routine checkup, what worries many people is not how they feel, but the new arrows that suddenly appear on their test results.

Their blood pressure is slightly above the recommended range. Their fasting glucose falls into the “prediabetes” category. Their cholesterol exceeds the reference level, or a bone-density scan shows “osteopenia.” These findings may cause no symptoms at all, yet they can make someone who previously considered themselves healthy begin to wonder: Am I already sick? Do I need medication? If I do nothing, could I miss the chance for early treatment?

In recent years, another explanation has spread across social media: Many people were never sick in the first place. The medical establishment simply lowered diagnostic thresholds, turned healthy people into patients, and created a reason for them to undergo lifelong testing and take medication indefinitely.

This argument reflects a legitimate concern about overdiagnosis and overtreatment, but it reduces a complicated issue to a simple conspiracy. Changes in medical standards can sometimes identify danger earlier. But if every risk is treated as a disease, and every diagnosis automatically leads to treatment, medical progress can also create new forms of harm.

How Did the Same Body Suddenly Become “Abnormal”?

The standards used to define many diseases have indeed changed over the past several decades.

In 1997, the U.S. diagnostic threshold for diabetes based on fasting blood glucose was lowered from 140 to 126 milligrams per deciliter. In 2003, the lower limit for impaired fasting glucose was reduced from 110 to 100. In 2017, the American College of Cardiology and the American Heart Association changed the threshold for high blood pressure from 140/90 to 130/80. Once the standards changed, many more people naturally fell into the categories of prediabetes or hypertension.

This can easily create the impression that nothing changed in the body; the medical establishment merely changed a number and “manufactured” a new patient.

But an older standard was not necessarily a guarantee of safety. As long-term evidence accumulated, researchers found that some levels previously considered normal were already associated with a higher risk of stroke, heart disease, kidney disease, or retinal damage. Lowering a threshold can therefore be an attempt to alert people before serious damage occurs.

Still, “higher risk” is not the same as “already sick.” A person’s body does not suddenly change when their blood pressure moves from 129/79 to 130/80. Medicine simply needs to draw a line somewhere along a gradually rising risk curve so that doctors and patients know when to pay closer attention.

That leads to the real question: Is this line a warning threshold, or a medication threshold?

Once a Condition Has a Name, the Process Tends to Keep Moving

From a medical perspective, slightly elevated blood pressure may require only dietary changes, more physical activity, and continued monitoring. Prediabetes does not usually mean that medication must begin immediately. But when the words “hypertension,” “prediabetes,” or “osteopenia” appear in a medical record, patients can easily interpret them to mean that they are already ill.

The healthcare system itself can also keep the process moving forward. An abnormal test result may lead to another test. If the result remains outside the recommended range, additional testing may follow. Once a diagnosis is entered, medication may be prescribed. Insurance rules, electronic alerts, and standardized clinical procedures all tend to trigger the next step when a particular number is reached.

Such systems can help busy doctors avoid overlooking patients who are genuinely at high risk. But they can also overlook important differences between individuals.

A patient who has previously suffered a stroke, has diabetes, and has smoked for many years is not the same as a low-risk person with no other medical conditions and generally healthy habits—even if their blood pressure readings are identical. Similarly, an older adult who has already experienced a fragility fracture should not automatically receive the same treatment as a healthy woman whose bone density is only slightly below average and who has never broken a bone.

When one number outweighs age, medical history, lifestyle, and personal preferences, a useful warning can gradually turn into overtreatment.

What Does “A 20% Reduction in Risk” Actually Mean?

When patients are offered treatment, they often hear a persuasive statement: “This medication can reduce your risk by 20%.”

That sounds impressive, but it may leave out the most important information.

Suppose a person has a 5% chance of developing a particular condition over the next ten years. A 20% relative reduction would lower that risk from 5% to 4%—an absolute reduction of only one percentage point. Among about 100 similar people who take the medication, perhaps one would avoid that outcome. The others would not receive that particular benefit, although all of them would bear the cost, inconvenience, and possible side effects of treatment.

Now consider someone whose original risk is 50%. The same 20% relative reduction could lower the risk from 50% to 40%. For that person, the value of treatment is clearly much greater.

The question, therefore, is not simply whether a medication works. It is how much it is likely to help the person sitting in front of the doctor. A low-risk patient deciding whether to take medication for many years faces a different calculation from someone who has already had a heart attack.

Unfortunately, patients often hear only the relative percentage by which risk may decline. They are rarely told: What is my risk if I do not take the medication? What would it become if I do? How many people like me must be treated for one person to benefit?

Without this information, “informed choice” can easily become little more than a signature on a form.

Who Decides Where to Draw the Line?

Medical guidelines are generally developed by specialists, researchers, and statisticians who evaluate the available evidence. The problem is that lowering a diagnostic or treatment threshold does not affect only patients. It can also expand the markets for medications, laboratory tests, screening equipment, physical examinations, and other medical services.

This does not mean that a guideline becomes fraudulent whenever an expert has ties to a pharmaceutical company. Industry participation in medical research is common, and many effective treatments have been developed by private companies. But when experts who help set medical standards have financial relationships with businesses that may profit from those changes, the public has a right to know and to demand stronger safeguards.

The important questions go beyond whether financial ties were disclosed. Were experts with major conflicts of interest allowed to participate in decisive votes? Were primary care physicians, geriatric specialists, statisticians, and patient representatives included? Did evidence against lowering the threshold receive equal consideration? After the standard changed, how many additional people were diagnosed or given medication—and how many strokes, fractures, or deaths were actually prevented?

If a new guideline tells the public how many people it may save but not how many low-risk people will receive a disease label, experience side effects, or undergo additional testing, then the review is incomplete.

Medical guidelines should be revised when the evidence changes, but revision cannot move in only one direction. If later studies show that certain groups did not receive the expected benefit, guidelines should also be able to raise treatment thresholds, narrow their recommendations, or advise some patients to reduce or discontinue medications that are no longer necessary.

Do Not Reject Prevention—but Do Not Obey a Number Blindly

Faced with this uncertainty, people do not need to treat every abnormal result as a serious disease. Nor should they reject useful screening or treatment simply because they are concerned about overdiagnosis.

A more practical response is to ask several specific questions when a doctor proposes a diagnosis or medication:

Does this result need to be confirmed with another measurement? Does it mean that disease is already present, or only that my future risk is higher? What other risk factors do I have besides this number? What would happen if I first changed my lifestyle and continued to monitor the condition? How much would medication reduce my actual risk? What side effects might occur?

These questions do not challenge a doctor’s expertise. They help the doctor translate a general guideline into a decision that fits the individual patient.

Modern medicine allows us to see danger earlier than previous generations could. But once a risk is discovered, the only choices are not “treat immediately” or “do nothing.” Repeating a test, monitoring changes, improving daily habits, assessing overall risk, or postponing medication can all be reasonable medical decisions.

What we need to prevent is not medicine drawing lines to identify risk. It is allowing one line to determine everyone’s fate.

Medicine can tell us where risk begins to rise, but a single number cannot decide whether every person has become a patient. Guidelines should provide direction, doctors should apply judgment to individual circumstances, and patients should understand whether they have received a warning, a diagnosis, or a treatment recommendation that is truly worth accepting.

By Voice in Between