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What Is “Normal” in the World of Medicine?

Normal is a malleable concept in medicine. Doctors are constantly testing individuals looking for abnormalities, but the reality is, no two humans are the same and the standard we compare our body’s health to may not represent the whole human family.

Decades ago, “normal” testing standards were determined based on studies of soldiers. Over time it has become apparent that when the rest of humanity is compared to fit 20-year-old men, the majority of the population will seem to have abnormalities or health issues.

What may seem normal for a young man is far from normal for a 60-year-old woman. Testing scales have advanced to vary by gender and other categories, but it remains hard to accommodate for age, race, and genetic differences.

According to this article in the Washington Post, we are all born with “defects” in varying degrees. Some of these defects, though, will never cause hazardous issues. Dr. Ashish Jha, director of the Harvard Global Health Institute at the Harvard T.H. Chan School of Public Health, says that paying attention to the effect the symptoms are having on the body is far more effective when deciding if more testing/treatment is necessary than deciding to treat abnormalities at the first indication of a difference. Some abnormalities may never lead to negative symptoms and may never cause the body harm.

Imaging for low back pain is one notorious example of this dilemma, as studies now show that bulging disks and other abnormalities are extremely common in people who have no back problems at all. In one study from the mid-1990s, researchers took MRI scans of 98 adults with no back pain and found that 64 percent had some kind of disk abnormality. 38 percent had more than one abnormality.

As physicians and patients decide if treatments are necessary, it is important to understand that finding something that is not “normal” is so very common.

The Nothing Cure

By Matthew Herper and Robert Langreth, From Forbes Magazine, Issue Date March 29, 2010

Instead of ignoring the placebo effect, doctors should try to enhance it, says a Harvard Medical School professor.

This interesting discussion on the placebo effect is worth a read. The presence of the placebo effect is well-known and generally accepted in medicine, though it may be frequently argued as to when it is taking place or not – especially when one’s own treatment is being questioned.

From a policy standpoint, a legitimate question is whether those treatments that have a significant placebo component are ethical to the degree there may be conscious deception on the part of the practitioner – on behalf of helping their patient. In addition, should third parties such as insurance or government be asked and expected to pay for placebo interventions?