Drivkrafter för sjukvårdsexpansion

Kurs i hållbar diagnostik, SLS

Staffan Svensson
Distriktsläkare & Klinisk Farmakolog
Nötkärnan Bergsjön VC
Rådet för Hållbar Diagnostik & Behandling (SFAM-H)

27 jan 2025

Material

Upplägg

  • Drivkrafter
  • Labb
  • Low-T
  • Obesitas

Drivkrafter

… bakom medicinsk överaktivitet

  • Vilja att hjälpa till
  • Tradition, riktlinjer, patienters förväntningar
  • Akademiska spår & kliniska käpphästar
  • Ekonomiska incitament, “vested interests”

Sjukdomsmångleri

Alias Disease mongering

“The boundaries of disease are fluid and there are too many vested interests trying to push these boundaries as wide as possible” (Lynn Payer 1990)

“Trying to convince essentially well people that they are sick, or slightly sick people that they are very ill – is big business” (Ray Moynihan 2002)

Citerade i: Lexchin J. Disease Mongering: Corporate Greed and the Creation of Disease. In: Encyclopedia of Pharmacy Practice and Clinical Pharmacy. Oxford: Elsevier; 2019. pp. 85–96.

“Of all the anti-social vested interests the worst is the vested interest in ill-health.” (Bernard Shaw 1909)

Shaw B. The Doctor’s Dilemma: Preface on Doctors. 1909.

Labbprover

Vitaminer

Low-T

Obesitas

Obesitas en sjukdom?

The idea of obesity as a standalone disease entity remains controversial both within and beyond the medical community.

Rubino F. et al. Definition and diagnostic criteria of clinical obesity. Lancet Diab & Endocrin 2025.

Although obesity should be biologically conceived of as a continuum, health and illness are typically (and necessarily) defined as distinct, dichotomous conditions at the clinical level.

Preclinical and clinical obesity pragmatically distinguish conditions where the negative health effect might occur (as in preclinical obesity) or has occurred (ie, clinical obesity).

Rubino F. et al. Op cit

The medicalization of obesity could detract from collective solutions to environmental forces that shape’s people’s behaviors and impact a number of conditions beyond just obesity

Council on Science and Public Health 2013, citerad i Vallgårda S. et al. Should Europe follow the US and declare obesity a disease?: a discussion of the so-called utilitarian argument Eur J Clin Nutr 2017:71(11);1263–1267.

⊕ & ⊖

  • ⊕ Ökad medicinsk och kulturell legitimitet

  • ⊕ Ökad tillgång till sjukvård

  • ⊕ Minskat socialt och psykologiskt stigma

  • ⊖ Friska människor med obesitas får onödig diagnos

  • ⊖ ⇒ Överbehandling

  • ⊖ Man individualiserar ett samhällsorsakat problem

TACK!

Länkar