## INTRODUCTION

The well-known physician and author Welch1 in his book ‘Less Medicine, More Health’ states that ‘as our diagnostic technologies become more and more capable of detecting minor abnormalities in our anatomy, physiology, biochemistry and genome, so many unexpected findings increased which may not be so unexpected’. This increase in the diagnostic capacity of our techniques is accompanied by an ever-increasing use of preventive examinations in people who are not always in actual fact ill but within such a context are ‘potentially’ ill. With a well-developed rhetoric about maintaining good health and the ever use of statistics, part of the population eventually becomes ‘potentially’ ill. Meanwhile, in many cases, the data and images we get from our technical devices are not sufficiently clear in what they reflect of the complex and multifactorial phenomenon of life.

## COMMENTARY

### Medical practice

According to Hippocrates ‘prevention is better than cure’, but the present medical reality has little to do with the reality of the time of Hippocrates. If it was so, the Hippocratic ‘Humoral Theory’ and Hippocratic treatments such as bleeding, purging and laxatives would be utilized to treat every human disease. The main pathogen of Hippocratic medicine was considered to be the disturbance of the balance between man and his natural environment but also with his corresponding daily biotic (diet and habits)2. By improving the way of life and diet, i.e. the interaction of man with the environment in which he lives, he prevents diseases which are an expression of this bad relationship between man and his environment. The Hippocratic approach to disease was an expression of the social perceptions and practices of his time and in line with the naturalistic approaches of the prosocratics.

Since then, the view of disease, as such, has changed. Its approach today is more technical, capturing the technological orientation of modern societies as well as its integration into the dominant productive model. In this context, and in order to maintain good health and the expectation of prolonging life expectancy, preventive examinations have increased dramatically.

Eventually, when something is found, it is very difficult to stop searching further, which leads inevitably to its ‘treatment’ or ‘overtreatment’. This is where real hazards start because an unnecessary treatment can harm us. Overdiagnosis, naturally, does not only concern the cases mentioned above but includes cases such as mild hypertension, autism, menopause, osteoporosis, diabetes type II, cancer, and gene control. Concerning psychiatric diseases, we encounter the same or even greater problems, as doctors continuously add new diseases to the therapeutic range of drugs. Therefore, by definition ‘overdiagnosis occurs when individuals are diagnosed with conditions that will never cause symptoms or death’3. It could also be said that overtreatment is a side effect of the accuracy of diagnostic methods. The possibilities and accuracy of diagnostic methods have dramatically improved in recent decades and have opened new prospects in medicine. The new depiction methods along with the patient’s presentation, bring about unprecedented assurance and safety to the physician’s work (medical authority). But have we ever wondered what exactly is depicted? What does the depiction have to do with the actual functional status of the potential patient? In relation to what standards and conditions is this depiction compared to?

In modern medicine, we do not focus on a single symptom but instead perform scrutinizing exams on many other systems without any form of association between the symptom and the other systems. This is called ‘passion for diagnosis’ and is a medical phenomenon, especially among young doctors. In essence, it is the fear of not giving enough attention to something and then ‘losing’ the patient. Unfortunately, in the days of particularly increased technological capabilities in imaging and biochemical control, diagnostic passion (i.e. early diagnosis) is also transferred to those who do not have symptoms and are simply afraid they will acquire them in the future. The issues raised here are: exactly what is depicted with these technical diagnostic means; in relation to what is this imaging to be compared to; and how is this model of comparison to be defined (if any) and who and in what way to handle this model and its requirements. Passion for diagnosis gradually transforms the individual into a patient. But how many people are there who will not only undergo a treatment that will not benefit them but will also put their lives at risk?

## CONCLUSION

Real medicine, good medicine, is that of ‘medicine of signs and symptoms’ and of child vaccination, not ‘laboratory medicine’ (namely clinical medicine – emergency or scheduled). Yet this medicine is not as lucrative as ‘bad medicine’, that is, blind diagnostic medical medicine without symptoms, medicines that only heal numbers above thresholds, interventions that are promoted by the companies that sell the robots and machinery that materialize them, i.e. medicine of ‘fear and profit’. Nowadays, lucrative is medicine that sells health as a product, or to be precise, sells normal body debilitation, which will inevitably come with time. It sells normal debilitation, after it first ‘defines’ it as a disease. So, this medicine only cares about profit and not the jobs it offers and its contribution to reducing unemployment rate, no matter how often pharmaceutical and biotechnology companies use this argument. Improving society’s health and decreasing unemployment are two different objectives and they should be treated in different ways using diverse interventions. The purpose of commercial development does not sanctify the means of pharmaceutical formulations or medical machines, like a ‘home oximeter’.

Of course, we should not avoid doctors when sick. The problem of overdiagnosis begins with ‘what we do when we are healthy’ and to what extend do we have to look for things that can pose risks. Does the search for a hidden disease place us in greater risk since many ‘diseases’ are not intended to harm us? Should the doctrine of early diagnosis (without support from the medical history and the symptoms) be revised since it has long been known that medical history offers 50% of the diagnosis while the routine examinations just 1%12? Should the blind game of probabilities, that is, the game of early diagnosis, be replaced with what we can actively do, such as stopping bad habits (e.g. stop smoking) and engage in better nutrition, start exercising, maintain normal weight, or avoiding risky behavior (speeding when driving) etc.? In our opinion, the biggest problem of modern medicine with philosophical, scientific, individual (mental), social, ethical, legal and economic ramifications is overdiagnosis.