The Pointless Promise of “You’re In Good Health”

Posted by Horton Tatarian, research biochemist, on 10th Feb 2018

The Pointless Promise of “You’re In Good Health”

The Pointless Promise of “You’re In Good Health”

What Does "In Good Health" Mean?

After a yearly check-up, a patient may be told "you're in good health" but then drop dead soon afterwards from a massive heart attack in the parking lot.

This is one of three scenarios raised by Herbert L. Fred, M.D. in an article titled, In Good Health: An Opinion At Best. His thoughts and those of other doctors caught my attention since they cover concerns relevant to you.

Dr. Fred was an 83-year-old Associate Editor of the Texas Heart Institute Journal when he submitted his article for publication in 2013. When younger, he was a professor at a school of medicine in Texas. His article begins:

The other day, one of our manuscript editors sent me the following note: “What does ‘in good health’ mean? Has it ever been defined? How might patients' and doctors' definition of that phrase differ?”

The editor likely expected a quick reply. "What does 'in good health' mean?" and "Has it ever been defined?" are simple questions. But Dr. Fred says:

At first, I considered those questions to be mundane, unimportant, and irrelevant. But the more I thought about them, the more intriguing they became, and the more variable and controversial their answers were. So I took the challenge and decided to delve into the matter.

Dr. Fred's Surprising Findings

At first, Dr. Fred found the question of "good health" irrelevant to healthcare. But, after he gave it thought, he found the question unsettling. So, he researched the meaning of "good health."

I started by seeking a precise definition of health. According to one of my medical dictionaries, health is “a state of optimal physical, mental, and social well-being, and not merely the absence of disease and infirmity."

Dorland's Medical Dictionary does not mention the source of the definition. The World Health Organization (WHO) created it in 1948 while forming its constitution.

Dr. Fred checked other dictionaries:

Another medical dictionary defines health as “the condition of an organism with respect to the performance of its vital functions especially as evaluated subjectively or nonprofessionally.” And a nonmedical dictionary says: “… freedom from disease, pain, or defect….”

These reputable sources indicate that health is a somewhat inexact entity with broad boundaries and differing definitions. Consequently, health can be interpreted in a number of ways.

We will study the interpretations of health as defined by medical experts later. For now, it is enough to see what Dr. Fred concluded.

Dr. Fred's Conclusions

Dr. Fred found a wide range of ideas instead of a useful definition of health. For this reason and others explained in his article, he concludes that the phrase "In good health" is worse than meaningless. It risks giving a false sense of security.

This mental exercise has changed my view of “in good health.” Heretofore, I had taken the phrase for granted and had never given it meaningful thought.

I have learned, however, that at the very best, it applies only to the moment at hand, provides no guarantee, risks giving a false sense of security, and represents nothing more than an opinion, professional or otherwise. Therefore, from now on, I will use the phrase cautiously and sparingly, if at all. (3)

A Surprising Weakness In Healthcare

One of the doctors that responded to Dr. Fred's article is Michel Accad, M.D., a cardiologist in San Francisco. He was surprised to learn that his profession has not defined basic terms used in health care.

One would think that, given the remarkable advances in medicine over the last 150 years, such basic concepts as “health,” “disease,” “illness,” and “wellness” would be sharply characterized. (2)

But how many doctors give thought to the meaning of these basic words? The lack of meaning for "health" did not come to Dr. Fred's attention until age 83 at the request of an editor. Dr. Accad was not aware of this issue before reading Dr. Fred's article.
But this flaw in key concepts used in healthcare has troubled other top doctors for many years.

Faulty Medical Definitions

In 1987, Dr. Harry Emson wrote an article titled Health, disease and illness: matters for definition. He was a professor of medicine in Canada at that time.
Doctors know that health is a disease-free state, and disease impairs health. But little guidance comes from defining health and disease in this way. Dr. Emson stated the problem thus:

The common circular definition that health is the absence of illness and that illness detracts from, diminishes or compromises health gets no one very far. (3)

Dr. Emson wanted doctors to ask themselves how they could discuss matters of health and disease without knowing what these terms mean.

Researchers Lack Direction

Scientists that research facets of health and disease need insight into the purpose of their work. We have seen the problem with circular definitions of health and disease.
The challenge is to identify the essence of health from a scientific point of view. This problem has troubled a community of scientists for a long time.

Healthcare Policy Makers Are Concerned

Many other experts share these concerns. Policy makers lack the direction that should be defined by the term health.

The definition problem in health can be seen as operational, nontrivial, and highly problematic to the determination of health care policy. (6)

This lack of direction has led to a growing crisis in health care systems worldwide. Health care policy determines the type of health care that you receive.

The lack of meaning in the terms health and disease has allowed the failure of health care to deliver on its promises.

The Misuse Of Healthcare Technology

The harm done by not understanding basic terms in health care goes further. The misuse of power created in the name of health care exposes people to harm.

Medicine is becoming more and more 'technologically' powerful. To protect patients, doctors and societies from misuse of this power it is necessary, as before, to indicate, as clearly as possible, the very purposes of medicine. Providing precise definitions of the fundamental concepts of medicine such as 'health'/'illness' ('disease', 'sickness') becomes in this context a crucial issue. (8)

About Horton Tatarian

Horton Tatarian image

I’m a biochemist who examines scientific findings on health and disease. My degree in biochemistry is from U.C. Berkeley. UCLA School of Medicine granted an M.D. degree in 1974. Since then, independent research prepared me to advise clients on natural ways of self-care.

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