How Many "Diseases" Are There?

It has long been the practice of clever advertisers to invent and name dreadful conditions, for which they offer a cure, profitably, of course. A similar tendency seems to apply to “medical problems”, where new and often complex syndromes, conditions, difficulties, and diseases seem to emerge regularly and often. It is one thing to generate the fear of “halitosis” and social ostracism that logically follows, however, as compared to inventing diseases and eliminating responsibility for them. At least part of the continuing dramatic inflation in sickness care costs is likely to be traceable to the increasing number of sicknesses that are being “discovered” in populations. And the less that government and commercial insurers agree to pay sickness care providers per service, the more there is an incentive to “discover” more conditions needing service.

If overweight/obesity -- along with sexual perfidy, gambling, and a host of other unhealthy and “anti-social” behaviors – are defined and treated as diseases, rather than correctable behavior problems, the potential for correcting them cost-effectively is diminished significantly. I recall when “behavioral health” was invented as a euphemism substitute for “mental illness”, which became politically incorrect in the socially sensitive 60s. But now, it has taken on the additional meaning reflecting the extent to which our behavior contributes to, threatens or harms our health. And the extent to which we are deemed responsible for such behaviors is a key element in social and economic policy with respect to them.

As a practical matter, if unhealthy weight is deemed a disease, or at least a condition significantly affected by “genetic pre-disposition”, which is easier to prove, then it becomes problematic for employers, insurers, or anyone else to discriminate between people of healthy vs. unhealthy weight. While clear behavior differences, such as smoking vs. non-smoking has survived as a reason for charging people more for their insurance, even for refusing employment, it is clearly at high legal risk to reward or punish people for behaviors that are affected by “diseases” or genetic differences.

While there is all but universal agreement that consumers need to become more responsible for their health behaviors and health/sickness care use, achieving an increase in responsible health behaviors will be much more difficult if there are no methods acceptable or legal for discriminating among healthy vs. unhealthy behaving consumers. Any diminution in or limitations on the consequences of health behaviors will obviously diminish consumer accountability. While employers are reportedly increasingly interested in using disincentives to influence employee health behaviors, the effects thereof would disappear if they became illegal or grounds for civil litigation. [M. Brill “Shape Up or Pay Up” MarketWatch.com July 29, 2010]

It may make sense to at least recognize that people differ in their innate ability to control their behaviors. Employers already are offering greater-value incentives for behavior changes generally recognized as more complicated or otherwise difficult to change, for example. But if health behaviors are widely deemed as caused by diseases, even this mode of discrimination might become prohibited, or at least risky for employers.

Today I read about what may be a particularly egregious example of this potential. Apparently a woman had been charged with killing her newborn babies in Europe, and at her trial, a psychiatrist testified that she suffered from “pregnancy denial”. If people cannot be held accountable for murdering babies, because a disease is suspected, it would seem unlikely that they can be so held for not keeping fit. [“Couple in Custody After 8 Babies Found in Plastic Bags” MSNBC.msn.com July 29, 2010]