Comments on: 10 cost effective preventive medicine services

By: kevin windisch

kevin windisch — Tue, 02 Feb 2010 22:16:48 +0000

Hands down preventive healthcare is a cheap investment compared to end stage tertiary care, yet we as a society continue to undervalue it and under pay for it. Vaccines are a perfect example- two of the top 10 largest employers in my state carve all vaccines out of their insurance plans if the child is over 2 years of age.

By: drcharles

drcharles — Wed, 27 Jan 2010 02:29:13 +0000

Might want to get your garden soil tested for heavy metals if you live near a road/city and that’s where all your food comes from, lots of lead in some areas. That’s gardening advice:
http://www.nytimes.com/2009/05/14/garden/14lead.html

Overuse. There’s a riddle in that word…

By: Fray

Fray — Tue, 26 Jan 2010 22:41:30 +0000

“I guess that’s what “Fray” was alluding to?”

No. I exercise, eat the food I grow in my garden, have a BMI of 19.2, can still run a fast mile, female and in my 40′s. I don’t smoke and drink very little. It’s a waste of time to check my cholesterol. I am not going to make any lifestyle changes that would decrease my risk of heart disease and I am certainly not going to take medication.

As an athlete, I am prone to muscle/skeletal problems but the doctors I have seen are too busy checking my cholesterol instead of preventing overuse injuries.

By: drcharles

drcharles — Tue, 26 Jan 2010 18:15:09 +0000

point taken. I would once again look at the big picture. I don’t think cholesterol screenings are the source of our hemorrhaging medical costs, and with the recent JUPITER study showing the importance of other cardiac risk markers such as CRP levels, the assessment of outwardly visible increased risk is only going to become more nuanced. I guess that’s what “Fray” was alluding to?

Anyway, be well.

By: Scientist

Scientist — Tue, 26 Jan 2010 13:58:57 +0000

“one such definition of ‘importance’ can be the synthesis of cost-effectiveness and preventable disease burden. Rather than quibble or parse through the exact wordings of USPSTF guidelines, I think the larger question was ‘what services provide the most bang for the buck?’”

But this is exactly my point of parsing through the exact wordings of the guidelines. The USPSTF guidelines are based on the premise it is cost effective and “efficacious” to screen women over age 45 that are at INCREASED RISK OF CHD for elevated cholesterol. The evidence suggests otherwise for women that are not at increased risk. If the National Commission “feels” (I say feel, because there is little evidence to support it) all women should be screened then they should just say so without misrepresenting the USPSTF’s recommendations.

My point is not to discourage preventive services for those with increased risk, but rather to discourage this trend of screening “well” people with no other risk factors for diseases. We have limited health care resources to treat the truly sick. If we attempt to screen and then “treat” conditions that have a neglible chance of increasing morbidity and mortality (but the treatments/screenings have a greater chance of doing harm) then not only does it bankrupt our system but also hurts the very few people that are still well!

By: Fray

Fray — Tue, 26 Jan 2010 04:53:07 +0000

One size fits all medicine…no thanks.

By: drcharles

drcharles — Tue, 26 Jan 2010 04:47:48 +0000

Thanks for posting. The overall message is simply that there are ways of stratifying preventive services by importance, and that one such definition of ‘importance’ can be the synthesis of cost-effectiveness and preventable disease burden. Rather than quibble or parse through the exact wordings of USPSTF guidelines, I think the larger question was ‘what services provide the most bang for the buck?’ This is what the National Commission on Prevention Priorities came up with. Perhaps your “alarm” would be best directed at these folks, whose resumes and credentials are quite respectable. Lifestyle modification and counseling people to take better care of themselves are important in addition to considering meds, as stated above in multiple arenas. Prescriptions drugs are really not mentioned in many of the top ten (2?) so there goes the conspiracy theory.

The ‘odious’ colonoscopy – I don’t want one either, but the alternatives as you know aren’t much more pleasant. Personally I’d like to avoid the radiation of the less invasive CT virtual colonoscopy, but the unpleasant prep remains. Fortunately colon cancer rates continue to drop as a result of better screening. I’m not sure about the status of stool genetic testing except that it is not part of the major guidelines yet. Would make for good future blogging.
Thanks KMD.

By: ninguem

ninguem — Tue, 26 Jan 2010 01:17:38 +0000

What’s the status of stool genetic testing for cancer?

By: Doc99

Doc99 — Mon, 25 Jan 2010 22:51:03 +0000

Regarding colon cancer screenings, whoever develops a truly noninvasive screen to replace the colonoscopy and its odious prep will win the Nobel Prize.

By: Scientist

Scientist — Mon, 25 Jan 2010 22:13:44 +0000

The website you are referencing as well as your above excerpts are wrong regarding cholesterol screening for women as well as hypertension recommendations. The U.S. Preventive Services Task Force DOES NOT Recommend: “Screen routinely for lipid disorders among all men aged 35+ and all women aged 45+. Instead, the USPSTF “strongly recommends screening women aged 45 and older for lipid disorders IF they are at INCREASED RISK FOR CORONARY HEART DISEASE.” There is a HUGE difference in these two recommendations.
Next, the referenced website states (implies) the USPSTF “recommend that blood pressure be measured routinely in all adults over 18 and that anti-hypertension medications be taken to prevent the incidence of cardiovascular disease.” NO THEY DO NOT. They only recommend screening and then discuss ways (pharmaceutical and non-pharmaceutical) ways of lowering blood pressure. They do not recommend anti-hypertension medications with a Grade “A”! The referenced website is full of other such errors. I’m a little alarmed that an MD would not have even noticed these discrepencies before posting these preventive screening recommendations.