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The medicalization of normal variants

The case of mitral valve prolapse

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Abstract

Mild mitral valve prolapse, hypoglycemia, irritable colon, and premenstrual syndrome are examples of anatomicophysiologic phenomena that largely overlap with normal. Such “overlap syndromes” become labeled disease entities by the medical community through a process called medicalization. This report uses mitral valve prolapse (MVP) to exemplify the effects of medicalization on patients, physicians, and society. Ascertainment bias and insufficient controlled clinical studies have led to the description of a clinical entity replete with false associations (e.g., mitral valve prolapse syndrome) and overly pessimistic prognostication (e.g., risk of sudden death or endocarditis), leading to clinical overreaction, overtreatment, and unnecessary induction of disability. Though some physical complications may be prevented by recognizing severe MVP, there is substantial risk of iatrogenic harm by attributing complex symptoms and illness behavior to mild MVP, which is probably a normal variant. A three-dimensional analysis of illness experience is presented that may be of use in conceptualizing the clinical approach to overlap syndromes such as mild MVP. Conservative criteria for the diagnosis of significant MVP have been developed at the National Institutes of Health. Treatment of patients with mild MVP must emphasize that it is a normal variant without serious consequences. Because the risks of overmedicalization are so substantial, the impact of diagnostic labels on individual patients and society must be analyzed continually.

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Authors and Affiliations

  1. Internal Medicine Division, Department of Medicine, The Genesee Hospital, USA

    Timothy E. Quill MD (Clinical Associate Professor)

  2. General Medicine Unit, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York

    Timothy E. Quill MD (Clinical Associate Professor)

  3. Primary Care Program, Department of Medicine, New York University School of Medicine, New York, New York

    Mack Lipkin Jr. MD (Associate Professor of Medicine, Director)

  4. Cardiology Unit, Department of Medicine, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, USA

    Philip Greenland MD (Associate Professor)

Authors
  1. Timothy E. Quill MD
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  2. Mack Lipkin Jr. MD
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  3. Philip Greenland MD
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Quill, T.E., Lipkin, M. & Greenland, P. The medicalization of normal variants. J Gen Intern Med 3, 267–276 (1988). https://doi.org/10.1007/BF02596343

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