Outlook: The Anxiety Industry

Medical Companies Have Americans Convinced That Every Pre-Condition Needs a Pill

"By constantly reminding us to be on the lookout for illness, doctors and the media have made many Americans feel more anxious. I'm not so sure their warnings have made us any healthier, but they have decidedly eroded our sense of well-being. We worry about every ache and pain; we fret that the least little sign of sadness in a teenager is a symptom of clinical depression. But in viewing so many aspects of ordinary human experience as treatable diseases, we may have granted medicine more power than it deserves - or is good for us."

New America Foundation senior fellow Shannon Brownlee, author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer," was online Monday, March 31 at 1 p.m. ET to explain how pharmaceutical firms have exaggerated disease risks and drug benefits, leaving Americans on-edge about their health.

The transcript follows.

Archive: Transcripts of discussions with Outlook article authors

____________________

Frederick, Md.: I wonder if you would be willing to address that most sacred of all medical rites in America today -- universal annual "screening" mammograms for every woman over the age of 50. Women are terrified of breast cancer, but where is the data that shows that universal screening of asymptomatic women actually does much, if any, good? Per Dr. Gil Welch of Dartmouth, there isn't any -- and in fact, the radical treatment of ductal carcinoma in situ, which is discoverable only by mammogram and about which shockingly little is known, has caused enormous suffering for many women. Yet we are being sold this expensive and frightening procedure as a necessity for life.

Shannon Brownlee: Thanks for your question. The controversy about mammography and especially how to treat DCIS, if at all, is a thorny one. I will try to get into it a bit as we go along, but I heartily recommend Gil Welch's book, "Should I Be Tested for Cancer?" It's available on Amazon and Dr. Welch does a better job than I could at laying out the risks and benefits of many cancer screening tests.

_______________________

Macedon, N.Y.: Blaming the pharmaceutical industry for the proliferation of these preventatives is correct, but it's only half the story. Being a fiftysomething woman who has had company-paid insurance for only brief periods of my working life, I can tell you that these very expensive drugs are much less attractive when you have to pay for them out of pocket. I went off hormone replacement therapy immediately when my insurance coverage stopped and I found out the real cost. Relief of hot flashes was decidedly not worth it! If insurance companies would refuse to pay for "quality of life" drugs -- Viagra being one of the most egregious -- you can bet they would disappear from the market, along with the conditions they "treat."

That said, I should mention that I have recently finished treatment for Stage II colorectal cancer, which matured to that stage because I ignored symptoms and was reluctant to shell out $1,000 for a screening colonoscopy. Having come through that experience with my health recovered (if not my colon or my bank account), I would urge you to include a brief caveat to your anti-screening message.

Early detection is very successful for preventing and minimizing the treatment costs (personal and financial) of colorectal cancer, among others. Please don't encourage people to ignore symptoms. I'm just now screwing up my courage to get back to the gynecologist (after a long hiatus) for the screening I know I should be doing for breast and ovarian cancer. But I won't be falling for (sorry) the bone density test. Just the basics, ma'am.

Shannon Brownlee: Ignoring symptoms of cancer is a bad idea. Once you have symptoms, you absolutely should go in to be tested.

Screening, however, is a slightly different situation. By definition it means looking for disease in asymptomatic people.

The most effective screening test for colon cancer is occult fecal blood sampling.

_______________________

Silver Spring, Md.: Ms. Brownlee, I'll start by saying that I have read your book "Overtreated," and I think it's an eye-opener. As a consumer of health literature, I often am dismayed at the lack of critical thinking in much of the health-related reporting that appears in the media. Often it seems that reporters take press releases and rewrite them, or just pass them on. It's almost as if the informed consumer should read everything that's released and then synthesize their own conclusions. As a health journalist, what are your qualifications?

Shannon Brownlee: I have a master's in biology and I've been reporting on medicine and health and science for 25 years.

_______________________

Denver: I welcome this article wholeheartedly. Very timely! The question I have is, why is there so little done by the government to propagate guidelines and advice for "good living" to promote a healthy lifestyle for the entire population? If I turn on the media, all I get are economics, politics and foreign affairs. I recall watching a morning show recently where a woman and her two children were given less than two minutes to show a great recipe, and tens of minutes were spent on Britney Spears's woes. Where are we heading?

Shannon Brownlee: Where are we heading? I think that's too deep a question for me! Thanks for your kind words about the article.

_______________________

Piedmont, Ala.: What are your thoughts on the scare tactics routinely used on pregnant and laboring women? American women have more ultrasounds, more cervical checks, more prenatal genetic screening and more interventions during labor than women in any other country -- yet our country's infant mortality rate is abysmal compared to that of countries with a less-medicalized approach to childbearing. Additionally, what is your advice for women who feel their pregnancies are being overmanaged, but are tired of being bullied into just one more procedure "to make sure the baby's really still okay"?

Shannon Brownlee: Yes, we seem to overtreat the educated and well-insured who are pregnant and then fail to offer prenatal care to the uninsured and impoverished.

_______________________

Burke, Va.: I was diagnosed with osteopenia four years ago. I am now 60. Both my internist and gynecologist have urged me to take Boniva; I have refused. They are both angry and impatient with me and seem to now view me as a "nut." They want me to have a new bone density test. I will not take any of the drugs even if I have additional bone loss. Both of these women have been my doctors for more than 10 years. I do not want to have to find new doctors, but am at a loss about how to resolve this. Any suggestions would be appreciated. Thank you for your refreshing article.

Shannon Brownlee: You're welcome. Ask them to go to the U.S. Preventative Services Task Force guidelines for osteoporosis and osteopenia. You can do the same yourself, the USPSTF is online. Good luck!

_______________________

Toronto: Thank you for a great article. Unfortunately it has caused me to develop Restless Mind Syndrome (RMS). Is there any treatment for this?

Shannon Brownlee: There's got to be a drug that's right for you! :-)

_______________________

Alexandria, Va.: Thank you for your very informative Outlook article on the proliferation of medications. I (age 65) yearn for the days before TV commercials and magazine ads made meds consumer-oriented. "Talk to your doctor about" ... "make your days symptom-free" ... thank goodness the companies are required to name side effects, some of which would be worse than the disease or disorder itself. My experience has been that when I talk to a doctor about a potential side effect, he or she brushes it aside as nothing to worry about. Yet I do worry, even though one of my meds is for anxiety/depression!

Shannon Brownlee: Our doctors have a duty to talk to us frankly and clearly about side effects so we can make informed choices about what the risks and benefits are. Try again -- tell your doctor you really want to understand the trade-offs so you can make a good choice. Good luck!

_______________________

Washington: I find it interesting (and disturbing) that network evening news now predominantly is sponsored by pharmaceutical companies. On any given evening, most of the commercials are pushing one drug or another aimed at us "baby boomers" who still watch the evening new. The younger generation gets their news elsewhere. The media pitches to its audience!

Shannon Brownlee: Television depends on the drug industry for ad revenue.

_______________________

New York: For the record, is your foundation or this book supported in any way by the health insurance industry or one of its professional associations?

Shannon Brownlee: For the record, no. The New America Foundation receives money from several sources, and my fellowship is specifically supported by an individual philanthropist who has absolutely nothing to do with health care.

_______________________

Linda7: Wonderful article! I just look at the many medicines that my friends take, in combinations that cause serious complications. Back about 20 years physicians were pushing hormones -- remember that? I refused them, and am glad I did. Now the physicians are pushing Lipitor -- I wonder what the long-term effect of that will be. TV ads also create more hypochondriacs!

Shannon Brownlee: Thanks for your kind words. We are becoming a nation of the worried well, even as we have 45 million people who don't have adequate access to care because they're uninsured.

_______________________

Waldorf, Md.: Great article. I think the direct marketing of pharmaceutical products to the consumer borders on criminal deception. Hasn't the maker of Prilosec been accused of misleading advertisements for the campaign they waged to get their Prilosec consumers to switch to Nexium as one of their patents expired? Nexium was marketed as the "new purple pill" that cured esophageal breakdown caused by acid reflux. I assume that esophageal breakdown is another pharmaceutical company created condition...

Shannon Brownlee: Esophageal erosion is quite real, but it's relatively rare, and so those of us (me included) who occasionally suffer from reflux don't really have to fret that it's going to turn into something more serious.

The real story of Nexium is that it is exactly the same thing as Prilosec -- or at least it becomes the same chemical entity once it is in the body. The maker of Prilosec came up with Nexium when Prilosec was going off patent and was about to face generic competition.

_______________________

Waynesboro, Va.: Big Pharma is in the business of making money, and they do so by inducing demand for their products. That shouldn't surprise anyone. What distresses me as a physician is that my colleagues go along to get along. With few exceptions, we have abrogated our responsibility to protect the patient.

Shannon Brownlee: Doctor, thanks so much for writing. You are in a tough position as a physician -- so much of your continuing education comes courtesy of Pharma, and there is relentless pressure on you from both patients and drug reps to prescribe. I hope my article, and even more so my book, will help patients understand how the health care industry works, and the influences on their behavior and that of their doctors.

_______________________

gwbush2323: The Medical Industrial complex has much power. I say a ban on TV ads for prescription drugs would be a fine start.

Shannon Brownlee: I'm with you! But it will be very difficult to put that genie back in the bottle, and the best I think we can hope for at least for a while is more accurate ads.

_______________________

Alexandria, Va.: Have you studied what types of "freebies" doctors accept for getting patients to try drugs that pharmaceutical representatives show them?

Shannon Brownlee: Yes, and if our doctor is still on line he or she probably can fill you in. The drug industry spends upward of $15,000 per physician on marketing, much of which goes toward free samples. Free samples, as one wag put it, are like free illicit drugs -- the first nickel bag of heroin is free. Doctors hand out the samples they have in their closets, and both doctor and patient often stick with that drug. Pharma hands out free samples because it increases sales.

_______________________

Washington: Your article reminded me of a book my father never fails to mention when talking of illness-related anxiety. The book is "Three Men in a Boat" by Jerome K. Jerome, in which the narrator, after consulting a medical dictionary one day, concludes that he has every illness in it except housemaid's knee.

Shannon Brownlee: The old joke among medical students is a that well person is somebody who hasn't been worked up enough. (A work-up is a battery of tests.)

_______________________

Los Angeles: Comment: If you feel you are being overtreated during pregnancy, try using a midwife rather than obstetrician. "Direct-entry" midwives are not certified in all states, but nurse-midwives are certified in all states and statistically are less likely to overtreat. Question: when you wrote that you do not intend to monitor your cholesterol, could you please share more of your risk/benefit analysis of that decision? Under what circumstances, would it be a good idea to get a cholesterol test?

Shannon Brownlee: Look, I'm not a doctor and I'm not supposed to give out medical advice. I can only say what I would do. I would get a cholesterol test if I had a family history of heart disease, if I had diabetes, if I smoked, if I were overweight. Your risk is increased by each of those conditions.

_______________________

ellenlawson: I am a registered nurse, and have see for myself the effect of bone thinning with age, and want no part of it. For osteopenia I take higher doses of calcium and Vitamin D, vitamin D being critical to calcium absorption (I now have normal bone scans, plus less trouble with my back). A fractured hip is no small matter, and once it happens -- depending on one's age -- death by other causes is frequent because of immobility.

For excessive acid, all one has to do is put four drops of AlkaLife in a glass of water or any other liquid that is acidic -- yes water is acidic, believe it or not -- and the acid/gas is neutralized. No prescription meds. As for blood pressure and heart meds, with the high incidence in my family of cardiac related events, I will take meds to control that as much as possible.

I agree that all this can be overdone, but, it would be tragic to lose sight of the very real changes that do happen in the body as we age and to not want to prevent the most serious ones if we can -- it is a fine line between being totally overboard and being sensibly cautious. I opt for the latter.

Shannon Brownlee: Agreed! Balance is the key.

_______________________

skbarrow : I work in a urgent care/primary care clinic and have been told by management to bill at the highest level and order as many tests as I can think of. Patients are overmedicated, overtested and overdiagnosed with little in the way of proof that anything I do will save lives. I can perform a very effective wallet-ectomy, however. I want so desperately to leave medicine, because it's all about the the money and little else.

Shannon Brownlee: Please don't leave medicine! You've spent a lot of time training and you clearly care about doing what's right for your patients. I hope you can find a hospital or a health care system that is a better place for you -- Kaiser is great. The VA, the Mayo Clinic, Intermountain Health Care in Utah, Geisinger Clinic in Pennsylvania. good places exist.

I hope you'll read my book, "Overtreated." It will resonate, I think.

All best wishes to you.

_______________________

Waynesboro, Va.: Is there a Web site that discusses medical overuse issues in layman's terms? I find that when I recommend against PSA testing or cholesterol screening, my patients will call back saying they read some doctor on the Web saying it absolutely must be done. And are there conferences where like-minded doctors get together to discuss these things?

Shannon Brownlee: Please urge them to read my book, Overtreated. I wrote it for my mother -- a smart woman who isn't a health care wonk. it's easy to read and will give them some perspective.

_______________________

Fredericksburg, Va.: How much has the loosening of advertising restrictions on pharmaceuticals helped power this phenomena? Watching the network nightly news broadcasts, nine out of 10 commercials are shilling for some drug.

Shannon Brownlee: DTC, direct to consumer advertising, has fueled the fire to a great degree.

_______________________

New York: Have statins by themselves (like Lipitor) proved their effectiveness in reducing heart disease? Have they proved their effectivesness among all populations? Thanks so much or the chat.

Shannon Brownlee: Statins very clearly reduce the risk of a second heart attack or stroke in populations under age 70. beyond that, the data are sketchy. So they are well demonstrateed for secondary prevention, but the vast majority of patients taking them are taking them for PRIMARY prevention, to prevent a first event.

_______________________

Falls Church, Va.: Wonderful article. As you can see from the many e-mails, the biggest obstacle we patients/consumers face is our own physicians. My aunt, in her 80s, was given Lipitor for her cholesterol. It upset her stomach and made her constipated. She stopped taking it and informed her doctor. The doctor wanted to give her some other drug. She told her no, she was 85 and her cholesterol was what it was -- nNo sense in spending the rest of her life being uncomfortable because of some perceived danger in her cholesterol. Just thought I would share that story. I will definitely be reading your book.

Shannon Brownlee: Despite the message I may have conveyed in the piece, I have a lot of sympathy for doctors. they are barraged with messages from the drug industry about prescribing, and they worry that if they fail to prescribe they will get sued. That said, I will never understand why we keep screening for cancer and keep giving drugs until the very end of life.

_______________________

Washington: Ms. Brownlee, fecal occult blood sampling is not even remotely an effective screening test for colon cancer. If you'd like, I can supply you with copious medical evidence to support that. I understand what you're trying to do, but please don't dispense incorrect and likely dangerous medical advice.

Shannon Brownlee: Actually, you're incorrect. fecal occult blood sampling has been demonstrated to lower the mortality risk from colon cancer. Colonoscopy may lower mortality, but it's not yet clear. that's why the NIH is doing randomized controlled trials of colononscopy, along with ct for lung cancer, prostate and ovarian cancer.

_______________________

Ban on TV ads for prescription drugs?: That genie may be, as you say, out of the bottle -- but then again, we eventually got a ban on tobacco advertising. I'm not saying it'll be easy to get prescription drug ads banned when TV is addicted to Big Pharma's ad revenues, but no doubt they once said the same thing re: Big Tobacco's revenues, and seem to have prospered in spite of the loss. So it can be done!

Shannon Brownlee: So start writing those letters to the editor! You're right, it can be done, but it will be tougher than cigarettes because unlike cigarettes, drugs do many people a great deal of good.

_______________________

Annapolis, Md.: Shannon, you listed Restless Leg Syndrome as one of the newly made-up conditions. I've had it for almost 51 years! Great article.

Shannon Brownlee: So has one of my best friends. it's a real disease, but the prevalence, or how common it is, is what's being inflated.

_______________________

Waynesboro, Va.: The fact is that Big Pharma spends more on advertising per year than is spent on medical education of all kinds. I largely have banned drug reps from my office. I get fewer samples to "help" my patients, and have to buy my own lunch, but can practice with a clear conscience. Doctors who say they can accept drug rep handouts with it affecting their prescribing are lying, delusional or both.

Shannon Brownlee: You're one of the good guys (or gals)!

_______________________

New York: I was told that the B vitamin complex that is recommended to lower C-Reactive Protein numbers had no effect on heart disease? Is that true?

Shannon Brownlee: Don't know.

_______________________

Falls Church, Va.: My father suffered from acid reflux, which developed into esophageal cancer. Earlier treatment with Nexium might have avoided that result. It's hard not to see your book and your comments here as essentially saying that because you've been fortunate in your own health so far, other people taking medication must just be complainers.

Shannon Brownlee: I'm so sorry to hear about your father. Yes, esophogeal cancer is real, and nexium might have helped him. But the fact that some people are helped doesn't mean everybody needs to take a drug. I don't need to take insulin even though insulin saves the lives of diabetics. It's a matter of finding the right balance without scaring everybody into thinking they are at risk for a very rare condition.

_______________________

Princeton, N.J.: Here are some facts mostly from Prof. Alan Sager of Boston University. Big drug companies spend about 10 percent of their budgets on research; most of the major advances come from the National Institutes of Health and universities. The companies spend about 20 percent on profit -- this is twice the average of other industries.

They spend more than 30 percent on marketing, the main purpose of which is to get physicians to prescribe new expensive drugs where older cheaper drugs work as well if not better. Marketing consists not only of the odious ads one sees everywhere, but also of the thousands of unqualified "pushers" who haunt physicians' offices, and of payments to doctors both direct (free lunches, consulting fees, etc.) and indirect (fake conferences at resorts, free transportation to meetings, etc.). Keep up the good work!

Shannon Brownlee: thanks!

_______________________

Washington: I really appreciated your column. Have you by chance seen " Unnatural Causes" on PBS? It was about health and status.

Shannon Brownlee: haven't seen it but I understand it's terrific.

_______________________

Bethesda, Md.: In your article you mentioned prehypertension and prediabetes. Please understand that no physician or medical advocacy group recommends actual medical treatment for these things -- just that patients who have high blood sugar but not quite diabetes, or blood pressure that is high but not technically hypertension, start making lifestyle changes do prevent actual hypertension and diabetes. Based on the tone of your article, this would seem to be the sort of thing you would support, rather than waiting until it's time to lop off a leg to think about treating something.

Shannon Brownlee: thanks for the clarification. yes, lifestyle changes first -- but you know there are physicians out there who reach for the prescription pad immediately in the belief that patients are a lost cause when it comes to changing their habits.

_______________________

Falls Church, Va.: I'm a 31-year-old who was diagnosed with osteopenia last year. My GI doc tried to put me on Fosomax, but because I became quite ill after taking it I've refused to take it since. Instead I've just starting taking vast quantities of calcium pills. Thankfully my general practitioner was okay with this (as was, grudgingly, my GI doc). The side effects of those medicines are just too much for me. I'd rather take my chances a more natural way -- eating ice cream!

Shannon Brownlee: i hope your doctors are also suggesting other ways to reduce your risk including exercise and vitamin d. good luck!

_______________________

New York: This discussion would suggest your book focuses on patients; I hope that isn't the case. I firmly believe any credible study would suggest Americans complain too little about maladies and visit the doctor too infrequently. What is more telling are issues such as off-label uses of drugs -- typically superficial uses among wealthier patients -- that are not legal in most countries of the world.

Shannon Brownlee: My book looks at the economic, intellectual, and cultural forces that drive the $500 to $700 billion we spend each year on unnecessary care. Some of it is driven by patients, but not the majority.

_______________________

Rockville, Md.: I would point out that finding something that doesn't happen is pretty hard. Just because there is less data on prevention of primary events based on statins doesn't mean they don't do so. The problem in this country is not just that screenings are overprescribed -- it's the lawsuits that force them oftentimes to be done. If a doctor does not do a specific screening, they can be sued for "missing something."

Moreover, just because someone doesn't think "quality of life" drugs are important, they can be. A healthy sex life is important in a marriage, and the lack of one for various reasons can decrease not just the quality of one's life, it can cause increases in blood pressure and other stress-related issues. This is similar to fertility issues, which people refuse to deal with as real medical issues.

Shannon Brownlee: sure, absence of evidence isn't the same as evidence of absence. But not every problem in life is a medical one.

_______________________

Chevy Chase, Md.: I am amazed by how much physicians organizations are influenced by big pharmaceutical companies. I am not affiliated with this organization, but have you looked into the National Physicians Alliance? They are a newish group trying to get the word out to doctors and patients about how the pharmaceutical companies affect our health care and ultimately our health. Great article -- hope to read more from you soon.

Shannon Brownlee: there are many great groups and many physicians working to reduce the influence of pharma on their practice.

_______________________

Waynesboro, Va.: Your book is great, and I do recommend it (along with "Selling Sickness" by Moynihan and Cassels and "The Last Well Person" by Hadler) but I would love to be able to point them to a Web site where they can look up evidence-based recommendations for their "conditions." WebMD, the most popular, is largely an advertising arm of the drug companies.

Shannon Brownlee: email me off line and we can come up with some ideas for you.

And you bet, both those other books are also excellent.

_______________________

Washington: Does anybody else out there have a complete distrust of the medical profession? I basically have the same attitude to doctors as I do toward auto mechanics -- I'm convinced they'll tell me there's something wrong, even when there isn't, just to see if they can get some money out of me. Do I have trust issues? Maybe I should see a psychiatrist!

Shannon Brownlee: there are many really wonderful, caring, and thoughtful doctors out there who merit our trust. I hope you find one. And no, you don't need a psychiatrist -- at least not as far as one can tell from your post!

_______________________

Not just an American situation: We have a French physician friend; French pharmaceutical companies send him on junkets that rival some congressional ones: So long as it's a Department of France, he gets to go to Burkina Faso, Cameroon, etc., or to medical conferences in the U.S. and Asia -- at no travel cost to him. Our postcard collection rivals some of the most exotic we know.

Shannon Brownlee: Lucky him.

_______________________

bobsnodgrass : Way to go Shannon. This doctor says that sleep apnea is common and important at all ages, but your credibility is much greater than that of The National Sleep Foundation and their coziness with makers of sleeping pills.

Shannon Brownlee: sleep apnea is a real problem. the question is how prevalent is it, and are the various therapies worth it in terms of real clinical outcomes. And I think what makes it all the more difficult for you as a physician is knowing what information you receive is credible.

_______________________

Crofton, Md.: Your article really resonated with me. I had just returned from the doctor after a bone scan who said I had "bad osteopenia" and I need to take Boniva, Caltrate D, and 1000 IU Vitamin D more. When I questioned him about side effects, he said to skip a dose if I was having dental surgery and refused to discuss further. It is hard to get a provider who actually will talk to you without "attitude." Meanwhile I will try to research this on my own, but your article expressed exactly how I felt, and made me think that it is not just "me." Thanks!

Shannon Brownlee: you're welcome!

_______________________

Arlington, Va.: Frankly, I'm more afraid of the big drug companies than these "conditions" their drugs treat. I am, of course, referring to the Heparin contamination article that was in yesterday's New York Times. The drug companies have gotten away with lax regulation for far too long, and using contaminated Chinese products is beyond nuts. I hope they get sued into bankruptcy.

washingtonpost.com: The Drug Scare That Exposed a World of Hurt (New York Times, March 30)

Shannon Brownlee: Not much chance of bankruptcy. they have very very deep pockets. And we don't want them to go out of business. they make a lot of truly beneficial drugs.

_______________________

Princeton, N.J.: Rockville -- it's not so hard. You take two similar populations, give one Lipator and not the other, and see if there is a stastically significant differences in number of first heart attacks.

Shannon Brownlee: The hard part is waiting for the clinically relevant events -- heart attacks, stroke and death. You need very large puplations of patients for such trials.

_______________________

B2O2:"I'd bet they'd answer like the respondents to a recent UPI poll, which found that a majority of Americans believe they'll live well into their 80s and beyond -- even though the average U.S. life expectancy is 77." This line in the article betrays fallacious thinking on the author's part. The life expectancy for people who already have reached a certain age is much higher than it was at their birth. The passage is an actuarially misleading line.

Also, I find it very annoying that, right at the point where the country is starting to realize what a big part preventative medicine will need to play in solving the health care crisis, the author is all up in arms that a drug company is wanting us to focus on bone health before someone actually breaks one. That's very silly, short-term thinking. The American pharmaceutical industry is guilty of plenty of sins (suppressing negative studies being near the top of the list, and one the media should be focussing on) but hyping preventative measures is not one of them, in my opinion. We need more of that, not less.

Shannon Brownlee: Sure, prevention is a great idea. But early intervention with drugs taht ahve real side effects is problematic on many levels. First, there are many reason women break bones in old age -- demntaia, dizzyness, the floor they walk on, the shoes they wear. second, most fractures occur in the very frail and elderly. they have multiple things going wrong with them, and a hip fracture is in many ways jsut the straw that breaks the camel's back. third, thre isn't much evidence that early intervention makes a clinical difference in outcomes.

you're right, the stats are a little muddy, but the point I was making was that we all think we are going to live forever, and the way to get there is by being hypervigilant.

_______________________

Baltimore: Re: Restless Leg Syndrome, the ad for the medication for this condition always makes me laugh, because of the disclosure that says "if you experience increased gambling or sexual urges, talk with your doctor." So, there is the possibility that dealing with annoying but benign Restless Leg Syndrome will turn you into a promiscuous casino denizen? Talk about the cure being worse than the disease!

Shannon Brownlee: thanks for that funny bit.

I'm signing off now. thanks to all for writing.

Shannon

_______________________

Tootsumi : I was hoping this article was going to focus more on "anxiety" -- which is a very real psychological condition that certainly can create very real physical/medical problems. It is clear that worrying and everything and anything creates the stress that leads to anxiety; however, once you're there, there are a whole hosts of ailments to contend with -- panic attacks, fibromyalgia, depression. They are very real and worth talking about.

Shannon Brownlee: yes, anxiety is a real ailment. But like many medical terms the word anxiety has a specific medical meaning and a more common meaning. I was thinking more about the common meaning, which is to worry and fret.

_______________________

Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.