Let’s (Not) Get Physicals

Stanley Feld M.D.,FACP, MACE

When  ELISABETH ROSENTHAL’s article was published in the New York Times on June 3,2011, I bristled.

This article could be President Obama’s way of using the traditional media to set us up for restricting access to care as the government is moving toward complete control of medical care.

In my opinion this New York Times healthcare article does not inform consumers.  The article Let’s (Not) Get Physicals confuse consumers.  

The article implies the US Preventive Task Force (USPTF) has advocated no more physicals and no more standard lab screenings.

“The last few years have produced a steady stream of new evidence against the utility of popular tests:

“Prostate specific antigen blood tests to detect prostate cancer? No longer recommended by the United States Preventive Services Task Force.

Routine EKGs? No use.

Yearly Pap smears? Nope. (Every three years.) 

The only routine blood test currently recommended by the United States Preventive Services Task Force is a cholesterol check every five years.”

The U.S. Preventative Services Task Force is a precursor to President Obama’s Independent Payment Advisory Board (IPAB). Many physicians object to a non-specialty board of physicians deciding unilaterally on best practices in specialties they do not represent.

One of my chief objections to the USPTF is its method of evaluating clinical research.

President Obama’s Independent Payment Advisory Board (IPAB) is going to reimburse physicians on the recommendation made by the USPTF without consulting subspecialty experts and dismissing clinical experience or judgment.

The USPTF should present its finding to the clinical specialists’ organizations in open forum for debate. There is plenty wrong with many of evidence based medicines’ conclusions.

Otherwise, the USPTF’s conclusions will simply undermine the patient physician relationship.

I believe I am qualified to critique the USPTF’s conclusions about osteoporosis in males.

The USPFT conclusions are dead wrong about evaluating and treating 70 year old men who might have osteoporosis. It is true that there are no large, long term, clinical studies evaluating the value of Bone Mineral Density studies and treatment of males over 70 years old for osteoporosis.

The USPTF concluded there is no clinical evidence to prove that osteoporosis evaluating and treatment in men is necessary. True, but it does not follow that if bone density studies are done and treatment started the treatment would not reduce the incidence of hip fracture by 50% as it does in women.

The incidence of osteoporosis in 70 year old men is high. All anyone has to do is go to a Wal-Mart anywhere in the nation on a Monday morning and stand at the front door. Clinical observation of retired 70 year old men will provide evidence for osteoporosis’ prevalence.

These men should be evaluated by bone density and then treated to prevent further fractures.

It would be cheaper for Obamacare to do this evaluation than restrict evaluation because of the lack of large studies to evaluate and treat.

The subsequent hip fractures will cost more in terms of morbidity, mortality and dollars than restricting access to early evaluation and treatment.

The government should collect the data to see how many men over 70 years old develop hip fractures. Then, calculate the cost of those hip fractures to Medicare against the cost of evaluation and potential treatment.

Males with osteoporosis do not present with back pain at the onset of a vertebral compression fracture. These fractures are mostly silent compared to women’s vertebral fractures. They will have a decrease in height and a low bone density.  

It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.

It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.   

“The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking and the balance of benefits and harms cannot be determined.”

 †For a list of current Task Force members, go to www.uspreventiveservicestaskforce.org/about.htm#Members.

I do not see one osteoporosis specialist in the entire task force group.

 The USPTF recommendation is in the vested interest of the government and the healthcare insurance. 

" Dr. Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine, has estimated that unneeded blood tests during physical exams alone cost $325 million annually.

The healthcare insurance industry and the government take 40% off the top of every healthcare dollar spent.

What percentage of the $2.5 trillion dollar healthcare bill is spent on the complications of chronic disease such as osteoporosis and other chronic diseases. The answer is 80% of the direct patient care dollars spent. The direct care dollars are $1.5 trillion dollars (150,000,000 million dollars) makes $325 million dollars a trivial amount at 2.16%. of the total spent on healthcare.

If Dr. Mehrotra was misquoted and the number is $325 billion dollars then the total spent on direct care for physicals and lab testing is 21.6%. or 11% of the total $2.5 trillion of healthcare dollars spent.  

To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending probably should be modified some but not discontinued.

It has been shown it takes 8 years from the onset of asymptomatic Type 2 Diabetes Mellitus for a complication, myocardial infarction to occur. Diabetes Mellitus is first discovered in the cardiac ICU 8 years after the onset of Diabetes.

It has also been shown that males avoid going to physicians unless they are sick.

If Diabetes Mellitus was discovered early and treated effectively, there is a 50% chance the myocardial infarction could have been avoided.

Many diseases  can be discovered on physical examination and routine lab testing. I takes time in the course of the natural history of a disease for the disease to become symptomatic or develop complications.

If discovered early and treated the complications of that disease can be avoided.  Many patients’ lives can be saved with proper treatment.

USPTF drawing conclusions without input from specialists is dangerous and irresponsible.

Ignoring the diagnosis can be more costly in the long run for the government than avoiding testing for the diagnosis.

I have pointed out previously the poor quality of some clinical studies.

The USPSTF by drawing conclusions on the basis of insufficient evidence and potentially defective clinical studies without consultation with the proper specialists must be avoided.

Unfortunately, it is going to get worse because there are no checks and balances in the Obamacare bureaucracy.

 Next I will discuss the PSA fiasco.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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