Reply to CNN report -- Autism: Could high U.S. rate be due to over-diagnosis?

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Reply to "CNN report -- Autism: Could high U.S. rate be due to over-diagnosis? "

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[quote=Anonymous]As to why the numbers are different in the US versus other developed western countries like, say, Canada, i'll give my theory (only a theory) as someone who grew up in Canada but has been living here for 15 years.  The health industry is a huge component of the US economy. As a total dollar amount and as number of people working within the health industry.  My experience is that this ever-presence of healthcare is self-perpetuating, and it plays a bigger role in people's lives here -- for better or for worse. I don't think any one actor is pushing health treatments on us - I think it's in doctors' interest to push it, but patients equally demand it more. Healthcare is all around us, ergo people want to use healthcare. Example: growing up in Canada, we had "colds". When I went to university, the American kids all had "sinus infections", "strep" and other medicalized terms. I remember we Canadians were amazed that the americans used to all go to the on campus health clinic to get antibiotics for these issues. They were just used to getting things named and getting things treated.

And carrying that over to what I see when I live in the states: I've had friends say that they couldn't live with single payer healthcare because they are used to using as much healthcare as they want and are okay paying extra for it. This was said in the context of wanting the freedom to go to 5 different doctors until she finally got someone to give her a diagnosis she was looking for.  I guess theoretically you could do this in Canada, but I think Canadians would cringe at the idea of what they saw as unecssary consumption of a social good.

I find that when I go to a doctor here, there is always a "diagnosis" and a treatment. Oh, my feet are sore and have grown a size since my baby was born - $650 orthotics from a specialist! And while he was doing it, my doctor noticed my baby toe turns funny - insisted on doing a treatment on the spot to cut a little muscle in the toe to release it. Insurance paid $1200.  If I went in complaining about those things in Canada, my general practitioner would check to make sure nothing major was going on, and then say "feet often grow after babies are born" and send me on my way.  And a Canadian would never think of going to a specialist to get a second opinion.  So knowing this context, chances are the average Canadian would never even raise the issue with a GP.

I'm not saying one approach is better than the other.  But I think both have pros and cons. In the US system, maybe more people who need treatment get it.  But it costs a lot of money. It costs a lot of time and stress on the patient's part.  There's something simpler in Canada about not even worrying that something is wrong. Yeah, my baby toe never got diagnosed and never got fixed. And sometimes it rubs weird in certain shoes. But life goes on fine.

So fast forward to SN diagnoses and I think we in the US are used to looking for answers from doctors about any variations from the norm. We're used to paying lots of money (if we have it) to get stuff fixed in the medical community.  So we are more likely to seek out a diagnosis to explain why our kid is different, and the doctor is more likely to recommend coming back for follow up appointments and seeking out therapy. We are all pieces in a big medical complex machine here.  So yes, that is going to lead to a lot more SN diagnoses. Some of those kids probably really have something that fits a diagnosis.  And in Canada, that diagnosis gets missed. But does it really matter? yes, treatment "helps". But so what if that kid just grows up to be a bit quirky but nonetheless successful engineer. Just like the uncle we all have in our family tree who clearly has the same issue but never got diagnosed.  The kids with big issues still get spotted in Canada and treated. But the kids who get diagnosed in the US and grow out of it (and we can argue about whether they were "cured" or grew out of it or never had it - but it doesn't matter) don't get diagnosed in Canada but also avoid years of money spent on therapies, doctors appointments etc, and the unended stress that gets heaped on the parents of special needs kids.  It's like mammograms - they're now saying that, statistically, all these fringe cases of breast cancer are not severe enough to warrant the money spent on therapy and the psychological trauma of getting diagnosed with cancer, when statistically those odd cells are unlikely to ever evolve in a dangerous cancer, and if they do, you will ultimately have other severe symptoms such that the mammogram is unnecessary.

Just my theory!![/quote]

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