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Posted May 11, 2015: by Bill Sardi
How does American medicine shed itself of practices that are no longer backed by science and deal with patient fears and at the same time deal with government efforts to produce more jobs in the healthcare sector?
How does American medicine shed itself of practices now invalidated by science? With Medicare facing a $23 trillion shortfall there certainly are no funds for extraneous medical tests and treatments that science no longer substantiates.
But unwinding many of these traditional hallmarks of American medicine, pap smears, mammograms, PSA tests, cholesterol blood analyses, even the annual physical exam, may be difficult because of patient fears and government efforts to produce more jobs for unemployed Americans.
First to address patient fears: the public wants assurances they are healthy. They want to undergo tests to prove that.
For instance, new guidelines call for younger low-risk women to undergo a Pap smear every 3-5 years, not annually. But a survey reveals many women feel uncomfortable with these increased intervals. Nearly half of women surveyed would prefer an annual Pap test. [Health Canal]
Ingrained patient fears may induce women to undergo what could be called “mindless medicine.” A recent survey revealed two-thirds of women underwent a Pap smear to test for cervical cancer even though their cervix had been surgically removed during an earlier hysterectomy. [JAMA Internal Medicine Feb 1, 2014] This practice has been going on for over a decade now. [Obstetrics Gynecology Aug 2001] A survey of studies spanning over a 40-year period found that a vaginal smear after hysterectomy only detected a single case of vaginal cancer among 11,659 women. Researchers conclude a vaginal smear after hysterectomy may induce anxiety and consume limited resources. [British Journal Obstetrics Gynecology Dec 2006]
And shame on their doctors for billing insurance for a totally meaningless test. However, a recently published report agonizes over the challenge of not offering a Pap smear to women who frown accustomed to it during their annual exams. [JAMA Internal Medicine May 27, 2013] The patient may feel their doctor is not thorough in his/her exam and go to another doctor who stills performs a needless Pap smear. So doctors, not wanting to lose patients, continue to do the test.
The PSA (prostate specific antigen) test is another example of mindless medicine driven by patient fears. In a recent article in The New York Times a physician agonized over how to convince a man he shouldn’t undergo a PSA test given that a recent long-term study did not support its use for prostate cancer screening. [NY Times Aug 19, 2014]
A published review shows that early detection of prostate cancer by PSA testing does not increase survival, that most men develop some cancerous cells in their prostate but only 3% are life-threatening and that 1 in 5 patients undergoing a PSA test will undergo a needless biopsy and that fearful men who undergo surgical removal of their prostate subject themselves to a high rate of incontinence and erectile dysfunction after surgery. [The NNT] Even the developer of the PSA test says it is an unreliable test. [Medscape Aug 8, 2014] But the mindless medicine continues. The studies pertain to groups of men. What does the doctor say when the patient asks: “What would you do doc?” Doctors are looking to drum up treatment and they don’t want to be characterized as being less of a doctor for not performing the PSA test. An estimated 20 million American men undergo PSA testing annually.
When an independent health panel issued a recommendation that breast cancer screening with mammograms do not need to begin till women reach the age of 50, politicians balked at this idea and there were concerns that health insurance would cease paying for mammograms for women in their 40s. Even though this edict was issued by an independent panel of experts various politicians responded by saying government should not intervene in personal healthcare decisions. Little or no mention was made of a false-positive diagnosis and needless treatment. [Nola.com]
The hallowed cholesterol blood test is another ceremony practiced throughout medical offices across the land. A study shows that 75% of patients arriving at a hospital following a heart attack had cholesterol numbers that were not alarming. [UCLA Newsroom Jan 12, 2009] As many heart attacks occur to those individuals whose total cholesterol is below 200 as above 200. But how does a person escape having this test? Life insurance companies typically require a cholesterol blood test to qualify for coverage.
An estimated 45 million Americans undergo an annual routine physical exam, a ritual that is now considered archaic. [Medscape Jan 15, 2015] Yet surveys show 92% of Americans mistakenly believe an annual head-to-toe exam is important. The cost: $10 billion a year. [CNN April 14, 2015]
In a contradiction of vast proportion, the federal government is looking toward the provision of more and more healthcare to an expanding number of senior Americans as the driving factor for jobs. According to the Bureau of Labor Statistics, healthcare occupations are projected to add the most new jobs over the next decade. [Bureau Labor Statistics]
The problem is, what if Americans learn to be healthier without all the doctoring? The anticipated jobs may not be realized.
So one begins to wonder why there are no approved medicines for cancer prevention, no medicine that truly prevents heart attacks or damage from heart attacks, but there certainly are ignored preventives in the published medical literature. [Pharmaceutical Biology April 9, 2015; Journal Nutritional Biochemistry June 20, 2009]
What prevents doesn’t create jobs. I’ve said this for some time now – human populations of the world are being gamed. Levels of nutrients required for health are dumbed-down to ensure there is a certain level of disease to treat in the population at large.
Aging Baby Boomers are living longer despite chronic health issues, just like modern medicine wants. Nearly 1 in 5 Baby Boomers have diabetes, 40% are obese and more than half take prescription drugs. [Medscape May 7, 2015]
What’s needed is more health and longevity without all the doctoring. What Americans are getting is the opposite. But a strong proportion of Americans want more doctoring, not less, and feel they paid into Medicare throughout their life and now deserve what they paid for. Some of this over-doctoring is at the insistence of the patients themselves who are driven by their own fears and need assurance they are healthy. How much is American society willing to pay for peace of mind. ©2015 Bill Sardi, Knowledge of Health, Inc.