Why would you not want to know?
by Kazeem Olalekan MRPharmS
Do you remember the Aesop’s Fable about the Fox and the Grapes?
A FAMISHED FOX saw some clusters of ripe black grapes hanging from a trellised vine. She resorted to all her tricks to get at them, but wearied herself in vain, for she could not reach them. At last she turned away, hiding her disappointment and saying: “The Grapes are sour, and not ripe as I thought.” (1)
The above is a fable about persistence. Might the outcome have been different if the Fox has been more persistent? One would never know. See how easy it was for the Fox to despise what seemed unattainable.
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You may wonder where I am going with this but bear with me. A number of things happened in the last few weeks that makes me ask the question: Why would you not want to know? Why would you not want to know why all of a sudden you feel lousy?…Why all of a sudden you feel tired all the time?…Why all of a sudden you simply stop feeling ‘right’? Something is wrong but you are reluctant to investigate what it is. In my experience, I am unaware of any serious medical condition that would not benefit from early diagnosis. Well, don’t trust my experience; let us examine the facts together. Table 1 is a pool of the effect of early diagnosis on some medical conditions:
| Condition | Effect of Early Diagnosis |
| Chronic Fatigue Syndrome (CFC) / Myalgic encephalomyelitis (ME) | About 25% of people with CFC/ME are severely affected (i.e. wheelchair bound, house-bound, or bed-bound, often with severe and even continuous pain. It has been suggested that those who were ill for more than a year before receiving a diagnosis from the doctor were more likely to be severely ill than those who waited less than a year. Only 27% of severe cases were diagnosed within a year compared to 54% of those with mild to moderately affected. (2) |
| Alzheimer’s Disease (AD) | ‘Early intervention is the optimal strategy, not only because the patient’s level of function will be preserved for a longer period, but also because community-dwelling patients with AD incur less societal cost than those who require long-term institutional placement.’ (3) |
| Multiple Sclerosis (MS) | ‘I think the point of making an early diagnosis is so that you can judge which patients you think need to be treated now as opposed to those you might want to wait to treat for 6 months or a year.’ Dr Freedman when asked by Medscape about a talk he presented entitle "Treat Early, Treat Right, Optimizing MS Therapy." (4) |
| Prostate Cancer (PC) | The prognosis for prostate cancer sufferers has improved dramatically in recent years. In the past twenty years the overall survival rate for all stages of prostate cancer has increased from 67% to 97%. Thus more men are living significantly longer after diagnosis. In all likelihood this is due to early detection programs, increased public awareness, particularly of prostate cancer symptoms, and the adoption of healthier lifestyles. (5) |
Table 1 - Effect of Early Diagnosis
These are just some examples and there are lots more. The prognosis (positive or negative) of any one disease can only be made after diagnosis. Armed with such fact, why might you not want to know if something is wrong? Any of the following could perhaps be possible reasons?
- The fear of the worst case scenario. Because you fear the worst, you might not want to know. I will say this: if you already have the worst case scenario, you have just raised the stakes without adequate treatment or intervention. If you take the example of prostate cancer, then you are denying yourself the chance of a near 100% cure by not acting soon.
- You are not insured. If you are in a society where you have to pay for healthcare and you are not insured (or cannot pay), then you might be at a loose end and might feel the best option is to not know since you will be in no position to deal with the financial consequence of knowing. I will advise you to carefully consider your options before making such a drastic decision. Helps are sometimes available from unlikely sources. Now let’s say you live in the UK, with the NHS and its characteristic free access to urgent medical treatment. Why would you still not want to know?!
- You knew someone who wanted to know but ‘what good it did him! He was dead before you could say fetch!’ You need to understand that people are different and diseases may affect people differently. What makes you think you have the same condition anyway? You are better off knowing, even if you are likely to die before you could say fetch! I bet you wouldn’t.
Now to my main point: If you consider all the really serious conditions, the early signs and symptoms may appear innocuous. Take Multiple Sclerosis, a common neurological condition affecting 1 person in 600 in the UK. One of the common non-specific symptom is fatigue ‘…associated with specific neurological symptoms, fluctuates with heat, exercise or as the day proceeds, and is alleviated by short period of rest’ (6). Now will you associate this symptom with MS straight away? No one can. Diagnosing these conditions can be a challenge in itself. Not everyone with fatigue will have MS! However, if after all explanation are exhausted and you still feel unwell, then you must not be the Fox in Aesop’s fable. Keep going back for further investigation and you may even buy yourself valuable time.
Have a merry Christmas and a Happy New year.
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Loading …Reference
1. http://www.aesopfables.com/cgi/aesop1.cgi?2&TheFoxandtheGrapes
2. ME Diagnosis: Delay Harms Health; Early diagnosis: why is it so important? A report from the ME Alliance; http://www.afme.org.uk/res/img/resources/ME%20Diagnosis%20Report%20master.pdf
3. Early Diagnosis of Alzheimer’s Disease: Clinical and Economic Benefits; Bennett P. Leifer, MD; J Am Geriatr Soc 51:S281–S288, 2003; http://www.blackwell-synergy.com/doi/abs/10.1046/j.1532-5415.5153.x
4. New Perspectives in Multiple Sclerosis: An Expert Interview With Mark S. Freedman, HBSc, MSc, MD
http://www.medscape.com/viewarticle/546714
5. http://www.articlehere.com/Article/Prostate-Cancer-Symptoms—Benefits-of-Early-Diagnosis/14242
6. Making the diagnosis of Multiple Sclerosis: J Palace: J. Neurol. Neurosurg. Psychiatry 2001;71;3-8, doi:10.1136/jnnp.71.suppl_2.ii3
http://jnnp.bmj.com/cgi/reprint/71/suppl_2/ii3.pdf