Not Every Disease Needs Treatment

Today a family member of a cancer patient I have long known consulted me by video about her mother. The mother has leukemia, gallstones, viral warts, and more. Children always worry about their parents; every time the hospital diagnoses something new she grows tense.

Often their local doctors cannot solve her mother's problems, so she comes to me. Some I can solve, some I cannot, but I explain which diseases need treatment and which do not. For her mother, asymptomatic gallstones and viral warts are not pressing and need no attention.

These diseases neither threaten life nor affect quality of life; with lifestyle adjustments and avoiding irritating and high-cholesterol foods, they will not worsen. Treating them may bring side effects and iatrogenic problems, even lowering quality of life and shortening survival.

Some patients and families over-fixate on being completely disease-free, ending up as pill-takers swallowing handfuls of medicine daily. Even then results are usually poor. I often slash the medication list, using simple drugs or lifestyle advice, and explain the illness to dispel anxiety.

I learned this from an American doctor I know. When patients came to him in China, he reviewed their drug list and prescribed almost nothing new, cutting the number of drugs by over half, sometimes 80%. He explained which diseases do not affect quality or longevity, and that lifelong medication harms. Once explained, families saw the benefits were not worth the harms.

Recently an elderly cancer patient told me by video she took a lipid-lowering drug from a junior clinic doctor with bad side effects. I told her to stop: hyperlipidemia was not her key issue, and her lipids were not life-threatening. Her tumor markers, however, were high and must be controlled. The lipid drug was interfering with anticancer treatment and lowering quality of life. Drugs must be coordinated holistically; endlessly adding drugs from lab data is irrational.

Many such diseases need not worry about; chronic diseases have become profit tools for drugmakers and bread-and-butter for doctors. Large clinical data show modest benefit from many chronic-disease drugs, but the public lacks this knowledge and obediently takes pills.

For example, by adjusting lifestyle—quitting smoking, limiting alcohol, cutting stroke risk factors—hypertensive mortality drops a lot, while lifelong antihypertensive side effects are not negligible. Most kidney stones pass with more water and exercise, no lithotripsy or medicine needed. Without lifestyle change, stones recur; treatment is only transient.

So when I counsel hypertensives, I spend time warning them of high-risk behaviors—staying up playing cards, sitting long then standing abruptly, straining at stool, emotional agitation, smoking, drinking—and tell them to avoid these, while brewing simple food-herb teas with blood-pressure effects (mint, Uncaria, corn silk). Many then normalize. I rarely medicate kidney stones; I rely on water and exercise. I have stones myself, recurring about every ten years, always passing them by water and ball games.

A doctor's value is not only prescribing but educating the public and guiding patients. Yet China's deformed system does not recognize that professional value, so doctors and institutions rely on tests and drug sales for income—causing burden, side effects, and endless disputes. The patient is not cured while new iatrogenic problems emerge; frontline risk soars. It is a lose-lose.

If doctors' labor is not valued—most Chinese accept only the value of drugs and tests—they must rely on gray income. This stems from chronically underpriced medical services. A doctor must learn many times more than other professionals, and knowledge renews fast; their time should be worth money.

Millions of doctors must feed their families; they cannot all be saints. China's medical fees are among the world's lowest, driving the deformed drug-subsidizes-medicine model that is now entrenched. Still, I hope Chinese medicine normalizes: patients' attitudes toward disease, doctors' transparent incomes, and no need for overmedication.