Wednesday, May 23, 2012

Whatever happened to an apple a day keeps the doctor away?



It’s sort of hard to imagine now, but there was a time when people actually avoided doctor’s offices and hospitals if at all possible. The conventional wisdom was that if you weren’t sick when you went into such a facility, you probably would be by the time you got out. Can you think of a more likely place to become exposed to an infectious ailment?

Cuts, scrapes, bumps, insect bites, colds and other minor ailments would resolve themselves as a part of the body’s natural healing process, and people just didn’t feel the need to visit their doctor as regularly as they did their barbers and hairdressers. Consequently, they didn’t get injected and tested for everything imaginable on a regular basis.

Somewhere along the line that apparently changed and today some people appear to be scheduling their lives around visits to their doctors’ offices.

I suspect part of the reason for those sliding frosted glass windows shielding the office staff from the waiting area is to prevent patients from observing the receptionist making faces at the people on the phone scheduling appointments. I can’t imagine anything worse than listening to people describing their ailments all day long and requesting, or even demanding, a prescription refill.

It doesn’t get any better at the multitude of pharmacies operating in every U.S. city. The pharmacists can barely keep up with the demand for prescription refills, despite all of the time-saving techniques for ordering refills by telephone, fax and e-mail.

Obviously, some people really are seriously ill and in need of medical treatment and large dosages of drugs, but it’s hard to believe there are that many people so seriously ill that they can’t survive without near constant medical care.

That appears to also be the opinion of medical researchers and other specialists who have begun warning their colleagues and the public that it is possible to over-test and over-treat.

The United States Preventive Services Task Force announced this week that the routine practice of performing blood tests to screen for prostate cancer in healthy men should be abandoned. The group reasoned that that the P.S.A. blood tests do not necessarily save lives and often set the stage for more tests and treatments that can cause other complications.

The task force doctors argue that the P.S.A. test is not effective in identifying a dangerous form of cancer, and that the positive results can be an indication of a slow-growing cancer that will never cause health problems. The follow-up tests and treatments, however may lead to pain, impotence and incontinence that could have been avoided.

The statistics reportedly show that one in six men in the U.S. will develop prostate cancer, and it is the most common malignancy in men. The disease is rare in men under age 50 and deaths from it usually occur in men older than 75. Last year, about 32,000 men died from it.

The same task force recommended two years ago that women in their 40s should no longer get annual mammograms because of the anxiety resulting from false-positives and unnecessary additional testing and the cost. It advised mammograms not be utilized until age 50, and then only every two years.

Breast cancer is the leading cause of cancer death in women. One in eight women will suffer from it, and about 40,000 women died from it last year, according to the American Cancer Society.
Some health experts also recommend that pap tests for cervical cancer in women be performed every three years instead of annually.

All of the recommendations for decreased testing for the different types of cancer are encountering strong resistance from some doctors, health organizations and cancer patients who warn that testing probably saved their lives.

Simultaneously, the results of a new study conducted at Texas MD Anderson Cancer Center on a breast cancer vaccine that may reduce the recurrence of the disease in patients is scheduled for presentation at the annual American Society of Clinical Oncology meeting in June in Chicago.

To be fair to the doctors who have ordered extensive testing for their patients over the years, most no doubt felt they owed their patients the benefit of every resource available to keep their clients healthy. Other doctors have acknowledged they sometimes over-tested to avoid the risk of malpractice suits in case their patients later became ill with a disease that might have been detected.

A 2010 Consumer Reports survey of 1,200 healthy adults showed half had screenings for heart disease that appeared to be unwarranted.

The American Board of Internal Medicine Foundation kicked off an initiative in April called “Choosing Wisely,” which urges doctors and patients to “wait a second” and consider carefully what tests and treatments should be undertaken.  The organization claims that many unnecessary procedures involving hospitalizations – estimated by the Congressional Budget Office to be 30 percent of the trillions of dollars of care delivered in the U.S. -- are driving up health costs needlessly and putting patients at unwarranted risks.
It has long been known that one of the biggest risks of entering a hospital for any reason is the threat of exposure to staph infections, which are widespread throughout U.S. medical facilities. Hospitals routinely document the number of staph infections in regular reports.

In cooperation with the ABIMF and nine other medical groups, Consumer Reports will be releasing lists of “Five Things Physicians and Patients Should Question.”  Visit: http://choosingwisely.org/wp-content/uploads/2011/12/about_choosingwisely.pdf

The guidelines for reduced testing apply only to patients who are healthy and show no symptoms of illness.
For anyone who is ill – especially when there is threat of a deadly disease present – anyone would be expected to do whatever they can to survive and would want their doctor to be on board with that. But otherwise, maybe a return to the more conservative approach of the past is in order.

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