Abstract

The morbidity evolution is uncertain. Not only in relation to the most obvious relationships, such as the evolution of bacterial resistance to antibiotics or genetic susceptibility to disease. Rather, this evolution of diseases over time and between countries is not explained in biologic changes but in contextual changes. And technological changes work to our advantage, but also to our detriment. There is a creation of new diseases, which result in giving pharmacological treatments for minor problems, increasing concern about future diseases in healthy populations, and converting personal and social problems into diagnosable health disorders and in need of pharmacological treatment. There is a medicalization of symptoms and risk factors. There is a recruitment of a greater number in diagnoses of chronic diseases through new detection and diagnosis technologies and the new disease definitions, as well as the equalization of risk factors with disease. It leads to overdiagnosis, over-treatment, multimorbidity and polypharmacy. This brings a dramatic increase in adverse drug reactions and drug-drug interactions. It is admitted that the mechanism due to causation, associations and links between diseases accounts for half of the reasons for accumulation of diseases, but the mechanism for iatrogenesis and complication accounts for another 10% of the causes of accumulation of diseases. Although it has long been known that the most important relationship on health is in psychosocial factors, current bio-technological evolution leads a new theory that complements the previous: multimorbidity and disease in general, in a small part but significant, can be created by the medical intervention itself. But it must bear in mind, that this mechanism could be prevented, so the presence of multimorbidity is not a natural and forced consequence of nature.

Keywords: Health care; Health expenditures; Drug-related side effects and adverse reactions; Overdiagnosis; Multimorbidity; Polypharmacy