“Paraclinical” examinations designate the innumerable techniques that complete the direct clinical examination of the patient: imaging, serology, microbiology, electrography, endoscopy, genomics, etc. Their purpose is to confirm or refute a diagnosis. The faculty taught to prescribe them only following having evoked one or two diagnoses. Some professors suggested making interns pay the cost of examinations with negative results, or to assess their usefulness following diagnosis: an MRI for tendonitis or Alzheimer’s disease does not change the care.
This parsimony makes you smile, today Social Security finances the mismanagement. The headlong rush is accelerating, fueled by the technical ingenuity and medical activism that society demands. Doctors no longer dare diagnoses without paraclinical confirmation, and patients consider these as suspect. This is why biomedical research is active in two directions, on the one hand, psychiatry where diagnoses remain exclusively clinical, on the other hand, screening for tumoral, cardiovascular and neurodegenerative diseases with the hope of delaying clinical appearance.
In psychiatry, retinal electrography helps in monitoring addictions, major depression and schizophrenia. We detected six biological markers correlated with the risk of suicide in bipolar and schizophrenics and eleven for major depression in adolescents. A neurotrophic factor helps predict bipolar disorder during a first depressive episode. Praise these efforts to distinguish serious psychiatric illnesses from mild mood or behavioral disorders.
Conversely, let us worry regarding the risks of diagnostic excesses and their commercial excesses. We have isolated a marker whose rate is higher in cases of post-traumatic stress, chronic fatigue or depression, all difficult and unstable diagnoses. Certain psychological contexts (rumination, stress) modify the rate of salivary IgA, but this rate also varies according to personalities. Some propose retinography to diagnose autism, anorexia, ADHD, even Alzheimer’s disease; the latter holds the record for scorers, we are at more than two hundred!
Cocasseries abound in other areas. Nuclear magnetic resonance spectroscopy can measure more than a hundred biomarkers at a time; big data has made it possible to discern 4 biomarkers strongly correlated with the risk of dying within five years. The decryption of the glycome (all of the body’s sugars) is a good predictor of cardiovascular and metabolic diseases; this is a prestigious way to confirm that sugar is bad for your health. The specter of osteoporosis has led to 7 million doses of vitamin D per year in France, but we still do not know its usefulness…
Biomedical research amazes me. It remains to monitor who controls it and to discharge the Social Security budget.
