President Dwight D. Eisenhower coined the term “military-industrial complex” when he left office to describe his concerns about the influence of the military. The phrase highlights the phenomenon of mission creep, where an industry expands into areas beyond its original scope. This concept has been paraphrased in various contexts, and the “medical-industrial complex” is one that is gaining traction. Essentially, it refers to the expansion of medicine into areas where diagnosis and treatment may not have been necessary before.
In a previous podcast, we discussed medical thresholds and how lowering them—whether for diabetes, cholesterol, or blood pressure—creates an entirely new group of people who were previously considered healthy but are now classified as having a condition that requires treatment. While sometimes beneficial, there is a noticeable trend toward overdiagnosis.
We now see the emergence of “pre-diseases,” such as pre-hypertension. Instead of simply categorizing blood pressure as normal, we now label it “pre-hypertension.” Similarly, pre-diabetes is a condition where a person does not have diabetes but may develop it in the future. To be fair, there is a grey area where blood sugar levels are above the recommended cutoff but not high enough to be classified as diabetes. The debate over pre-diabetes diagnosis continues. One public health expert argues that physicians should be more cautious in diagnosing pre-diabetes due to the potential harm it can cause. Another expert contends that early diagnosis is crucial to preventing serious health issues. Others suggest that treatment for pre-diabetes should be tailored to each patient, with lifestyle changes as the first line of defence and medications considered only if lifestyle modifications fail.
Disagreements among experts are common in medicine, as they are in many other fields. With so much expertise available, one can often find an expert to support any perspective. However, the fundamental question remains: Is pre-diabetes truly a medical condition, or is it simply a risk factor that may or may not lead to disease? This critical discussion is often overlooked.
There is also debate over when and how to screen for pre-diabetes, which essentially involves checking blood sugar levels. Type 1 diabetes, where the body does not produce insulin, usually manifests in childhood and requires lifelong insulin treatment. Type 2 diabetes, on the other hand, typically develops later in life and is strongly influenced by lifestyle factors, though genetics can also play a role. The real question is whether we need to label people with pre-diabetes or if we should simply focus on maintaining a healthy lifestyle. Regular exercise, a balanced diet, and a healthy weight reduce the risk of numerous conditions, including diabetes, high blood pressure, stroke, heart disease, and even some cancers.
Instead of classifying people as having pre-cancer, pre-diabetes, or other “pre-conditions,” perhaps we should recognize that they are healthy until they are not. While blood sugar levels may rise over time, leading to diabetes, it is not a certainty. A person on the road to a destination has not arrived until they reach it—and they can always change direction. Similarly, people diagnosed with Type 2 diabetes can, in some cases, reverse or significantly improve their condition through dietary changes and other lifestyle modifications. Some may still require medication, but others can reduce or even eliminate their need for it.
Labelling individuals with a condition they do not yet have can lead to unnecessary anxiety. For example, someone diagnosed with pre-diabetes may feel that developing diabetes is inevitable, which is not necessarily true. Additionally, medical labels can affect insurability, raising ethical concerns. If a diagnosis is warranted, it should not be hidden—but we must first determine whether a condition truly exists.
Ultimately, rather than focusing on avoiding specific diseases, we should emphasize overall health and well-being. While there is some overlap between these approaches, they are not identical. Attempting to navigate an obstacle course of potential diseases can be overwhelming, whereas striving for holistic health—caring for the mind, body, and spirit—makes it less likely that we will develop illnesses. Of course, there are no guarantees in life; accidents and unforeseen health conditions can still occur. However, prioritizing health increases the likelihood of staying well.
In my book, I coined the phrase, “The best way not to be sick is to be healthy.” While some people disliked it, I believe it captures the essence of this discussion. By focusing on health, we reduce the likelihood of disease—not eliminate it, but significantly lower the risk.
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For further reading on this topic, refer to the article: Experts Disagree on Whether Prediabetes is Overdiagnosed – What You Should Know published by Medical News Today.
Dr Joe Kosterich – Doctor, Health Industry Consultant and Author
Doctor, speaker, author, and health industry consultant, Joe is WA State Medical Director for IPN, Clinical editor of Medical Forum Magazine, Medical Advisor to Medicinal Cannabis company Little Green Pharma and Course Chair, and writer for Health Cert. He is often called to give opinions in medico-legal cases, has taught students at UWA and Curtin Medical schools and been involved in post graduate education for over 20 years.
A regular on radio and TV, Joe has a podcast – Dr Joe Unplugged, has self- published two books and maintains a website with health information. He has extensive experience in helping businesses maintain a healthy workforce.
Past Chairman of Australian Tobacco Harm Reduction Association, current Vice President of Arthritis and Osteoporosis WA, Joe previously held senior positions in the Australian Medical Association and has sat on numerous boards.
