There is no doubt that we are living longer, but the question is: are we better off for this longer life?

According to modern medicine, we are not. The UK’s International Longevity Centre released a statement announcing that less than a third of us will reach the typical retirement age of 65 in a healthy state.

In the US, one in every five will be 65 or older by 2030, and the over-85s are the fastest growing segment of the US population. Americans are older than ever before, but not necessarily healthier.

Similar statistics apply Europe­wide. Some 14 million people over the age of 65 have reported some sort of disability, mostly linked to chronic conditions, such as heart disease. This translates into one in five who is impaired with a major illness.

That is according to the doctors; however, their statistics rely on how they define health and illness. This definition is an interesting subject because it seems that by today’s terms, we define illness for many more conditions than we used to.

This means that more people are ill than ever before. Subsequently, more people are taking medication for what may not be defined as a serious illness. Some are taking medication for a minor ailment, which has then resulted in side effects and further medication.

What we can now define is a term known as ‘the new ill’. One-third of people who are under medical care would have been considered healthy a generation ago. The proportion is even higher for some conditions, such as high cholesterol, prostate cancer, attention deficit hyperactivity disorder and asthma.

Many millions of people worldwide have been caught in the medical net as definitions of disease have become tougher. To give a good example: literally overnight, 6.7 million American women suddenly had osteoporosis requiring medical treatment; the previous day they were borderline healthy.

How did this happen? The US National Osteoporosis Foundation (NOF) set a new and tighter definition of the disease. Osteoporosis is determined by the T score, which measures bone density and is set at zero, based on a healthy premenopausal woman.

An older woman, past the menopause, is likely to have a negative T score, and the World Health Organisation arbitrarily set the T score for osteoporosis at minus 2.5. However, the NOF moved this to minus 2.0 in 2003, so creating a new market of six million women who suddenly required drug therapy.

The same situation occurred a decade earlier when medicine tightened up its definition of cardiovascular disease, and in particular, blood pressure and cholesterol levels. In 1997, the danger level for high blood pressure was changed from a reading of 100/160mmHg to 90/140mmHg, suddenly making 13 million Americans candidates for antihypertensive drugs.

A further 42 million Americans found themselves, overnight, in line for a statin drug when the harmful level of cholesterol in the blood was lowered from 240mg/dL to 200mg/ dL or over. As most healthy people have a cholesterol level of around 200mg/dL, the new definition cast the disease net very wide (BMJ, 2012).

One third of people who are under medical care would have been considered healthy a generation ago

In addition, the mass screening programmes for cancers using increasingly sensitive technology are detecting cancers that will never endanger life, and usually the abnormalities are benign (Arch. Intern. Med., 2011).

Definitions of disease are driven by a desire to catch problems at an early stage – and find more customers for drugs. Many of the regulators who sit on the boards who determine at what stage a disease begins, have direct links with a pharmaceutical company, usually one that stands to benefit from a larger market for their drugs, says medical resear­cher Ray Moynihan from Bond University in Queensland, Australia.

A change of the definition of what is a disease is one driver of the epidemic of over-diagnosis; the other is sophisticated screening technology that allows a medical practitioner to see an abnormality even before it escalates into a disease.

However, new technology can also detect an abnormality that will never develop into a disease. This phenomenon, referred to as a reservoir of abnormalities, has been highlighted by researchers who screened healthy individuals with no symptoms, but nevertheless found facts such as these:

Around 10 per cent of us have gallstones, as detected by ultrasound, but never display any symptoms such as pain, nausea or problems with fatty foods (Invest. Radiol., 1991).

Around 40 per cent of us have knee damage, as detected by MRI scans, but have no history of pain or even knee injury. Finally, more than 50 per cent of us have bulging lumbar discs, according to MRI scans, but have never experienced any back pain (N. Engl. J. Med., 1994).

Here is the silent majority who are walking around with medical problems that will never give them any pain. Next week, we will look at who the ‘new ill’ are.

kathryn@maltanet.net