In his most recent piece for The TLS, hospital doctor Druin Burch writes:

The optimum amount of medicine to have in your life is the minimum possible, and private healthcare lacks the essential spirit of parsimony. A fee-for-service system rewards those who do as much as possible, not the thoughtful minimum. Those who can pay for everything run the risk of getting it.

As so often with Burch’s writing, I find myself both agreeing and disagreeing.

First, the disagreement: the optimum amount of medicine is not the minimum possible. This is self-evident. It is perfectly possible to live your life without a measles vaccination. Most unvaccinated people will not catch measles. Yet failing to get a measles vaccination is far from ‘optimal’: it forgoes the tiny risks associated with vaccination in favour of the much greater risks of acquiring disease, and it puts others at unnecessary risk.

But the wider point—that too much medicine is bad medicine—is a truism that’s too little discussed. I was amazed to read recently about Zoe, a programme that uses real-time blood glucose monitoring, genetic sequencing of gut bacteria, standardised meals with associated blood tests to create a diet plan. Perhaps medicalising one’s diet to that degree is helpful for some, but it’s not something I’d sign up to.

My gut reaction to all of this is that I don’t want to be unnecessarily investigated for anything, nor screened without good reason and evidence. Most incidental findings are unhelpful, resulting in further investigation and sometimes treatment which is entirely unnecessary—and where the benefit doesn’t come close to outweighing the harm.

My view on this is, in theory at least, pretty firm. But theory is not reality: as I type this, I can also see my Apple Watch, silently and continuously screening me for atrial fibrillation. I have scales at home which screen me with each use for peripheral neuropathy. My bed monitors me for sleep apnoea. I occasionally take my body temperature, even when I’m feeling well. This stuff is insidious, and it’s not necessarily good for overall health.