RELICS FROM A BYGONE ERA
One of the first things that Gold did was quote a statistic from a 2007 issue of JAMA Internal Medicine (Preventive Health Examinations and Preventive Gynecological Examinations in the United States). Although the ball had already been rolling concerning bailing on Annual Physicals, this was the study that pushed things over the edge when it comes to the way we think (or at least should think) about Annual Physical Exams. Here are a few excerpts from that study.
- Annual PHEs or preventive gynecological examinations (PGEs) (also called annual pelvic or gynecological examinations) are not recommended by major North American clinical organizations.
- Some observers have raised concerns that preventive visits are an inefficient use of physicians' time.
- Women receive a significant fraction of mammograms at preventive visits.
- Unnecessary laboratory testing is frequently ordered at these appointments.
Taken from the study above, Gold revealed that, "more than 44 million Americans are taking part in a medical ritual: visiting the doctor for an annual physical exam. But there's little evidence that those visits actually do any good for healthy adults." My guess is that her eight year old statistic is way out of date, and actually much higher than this. One of the many provisions of President Obama's oxymoronically named 'Affordable Care Act' is that it is supposed to make Preventive Health Examinations (PHEs) and Preventive Gynecological Examinations (PGEs) completely free of charge and not subject to deductibles or co-pays simply because they are believed to be critical to a healthy society.
A 2014 poll from Kaiser's Family Foundation (Kaiser Health Tracking Poll: November 2014) showed that even though more Californians were against the AFA than for it, well over 90% of those polled believe PGE's and PHE's to be a good thing, and nearly two thirds went to their doctors or practicioners to get those free Annual Examinations (PGE's and PHE's). Stick with me and I will show you why this does not do what you have always been told it does --- save lives and prevent chronic illness.
Earlier I mentioned the word "prevention". The problem is that the medical community continues to confuse early diagnosis with PREVENTION, and then propagandizing that it is the single biggest key to "curing" a wide array of physical ailments. This simply is not true. Maybe in the distant future, but not then and not now. Although one of the arguments given in the article is cost (Annual Physicals cost tens of billions of dollars a year), the main drawback has to do with something called "False Positives". False Positives are test results that say you have a disease when you don't. This leads to something the medical community has coined as OVER-DIAGNOSIS & OVER-TREATMENT, which unfortunately, often leads to premature death (HERE). It is virtually impossible to wrap your mind around the fact that Annual Physicals can cause more harm than good without understanding these two simple yet conncted-at-the-hip concepts. (A great piece on this topic is from last June's Journal of the American Medical Association ---- The $50,000 Physical).
Speaking of cost, although the article claims the average Annual Physical will run you in the neighborhood of $150.00, the internet is awash with examples that are much higher. One example came from the website CostHelper dot com (How Much Does an Annual Physical Cost?). It contained a common theme I saw all over the web while researching this post. It seems that many doctors (and even nurses) are ordering tests that patients did not want or need as part of the physical. A woman from Reedly, California stated that, "The clinic made sign a letter saying I am responsible for all the extra costs that are not covered by my insurance, otherwise I don't get service. But the letter never gave me the choice to pre-approve tests or to verify if I can afford it." She was pissed (upset is not a strong enough word) because her "free" physical ended up costing her over $700.00.
Despite Gold's article revealing that since the 1980's there has been ample "EVIDENCE" showing that Annual Physicals are not all they're cracked up to be, the medical community at large continues to recommend them anyway ---- something I WROTE ABOUT a couple of years ago, after writing an article on the same topic I am covering today (HERE). The point is, this is nothing new even though most of you have never heard it before.
Ignoring Evidence-Based Medicine in favor of something called Eminence-Based Medicine, physicians argue that patients (especially elderly patients) need the Annual Physical in order to get their VACCINES --- most particularly their FLU SHOTS. Let's be real for a moment. Flu Shots can be had almost anywhere, including Mal Wart or the franchised Pharmacies found on almost every corner of every major urban area. And if you click the link, current peer-review will let you in on yet another of medicine's dirty little secrets (that every doctor is or should be aware of) --- flu shots for the elderly are basically a placebo.
Below is the Annual Physical's "Top Eight" list taken from Preventive Health Examinations and Preventive Gynecological Examinations in the United States. Follow along as I pull back the curtain and show you what the Great and Powerful Oz really looks like.
- MAMMOGRAMS FOR WOMEN: If you are a woman, you need to read the earlier link about Overdiagnosis & Overtreatment. HERE is the scoop on mammograms and HERE is the low down on the Annual Female Examination as well.
- PROSTATE EXAMS FOR MEN: Same thing. A PSA TEST is no longer part of the normal Standard of Care for men for good reason.
- PAP SMEARS FOR WOMEN: The American Academy of Family Physicians says on their website, "Don't perform Pap smears on women under the age of 21 or women who have had a hysterectomy for non-cancer disease." Honestly, if you want to see the whole scoop, just Google "unnecessary PAP smears" and start skimming titles.
- CHOLESTEROL SCREENINGS: Why bother with screening when most doctors have already made up their mind about what to recommend? According to the latest research, doctors are pushing almost everyone to get on Statin Drugs (HERE and HERE). If you are interested in seeing some of the reasons you might not want to take statin drugs, HERE is a good place to start.
- SMOKING CESSATION: Noble sounding. Extremely ineffective and cost-inefficient. HERE is our information on smoking.
- WEIGHT LOSS COUNSELING: When is the last time a doctor provided any sort of meaningful counseling on WEIGHT LOSS aside from recommending WEIGHT LOSS DRUGS or BARIATRIC SURGERY? See the last bullet point below. Oh; HERE is an article about how effective (or not) Medicare-provided weight loss counseling really is.
- EXERCISE COUNSELING: Other than a generic, "be sure to exercise Mrs Smith," when is the last time a doctor provided any sort of meaningful counseling on SPECIFIC EXERCISE PROGRAMS to their patients? Plainly stated, they don't.
- NUTRITIONAL COUNSELING: NUTRITIONAL COUNSELING from the average MD? Surely YOU JEST? Why not simply admit that 99% of the time, points 6, 7, and 8 are not occurring in any sort of meaningful way in 99% of the medical clinics here in America? But when it comes to this particular bullet point, I simply want to laugh out loud. Mostly because the average doctor knows less than you do about nutrition, is withholding the truth, or outright lying to you (HERE and HERE). HERE'S how utterly simple it would be for the average physician to help their patients out in this department.
Case in point; Gold's article ends with an "encounter" (an Annual Physical Examination) between a Miami physician (Dr. Caruso) and his early 30's patient (Mr. Vega). The doctor paints a what-if scenario to make his case for the Annual Physical. The final sentence says that, "Vega did end up needing a little help -- he has a bad back that's landed him in the ER several times. Caruso was able to link him up with a back specialist to help him manage the problem." This is how skewed our system really is. What kind of "management" is a "back specialist" going to provide Mr. Vega in order to help him effectively "manage the problem"? You already know the answer to this. PAIN PILLS, MUSCLE RELAXERS, NSAIDS, and CORTICOSTEROID INJECTIONS ---- and eventually SPINAL SURGERY. It's what back specialists do. Might there be a BETTER WAY?
A brand new article from this month's edition of JAMA (What Is the Right Number of Clinic Appointments? Visit Frequency and the Accountable Care Organization) might help shed some light on this topic. This study says that Americans, "make 1 billion visits to physicians’ offices every year." Note that this does not account for hospitalizations, which are a whole other animal altogether. This is interesting in light of the fact that as a nation we are broke. No, that's not really true. We are officially 20 trillion dollars in the hole (unofficially more like 120 billion), and our government is finding it increasingly impossible to pay for your visits to the doctor, which cost, "nearly $600 billion" annually. Enter ACO's.
According to this study, "Since the Affordable Care Act mandated the creation of ACOs for Medicare beneficiaries in 2010, more than 600 public and private versions of the ACO have been created covering more than 18 million patients nationally." ACO's (Accountable Care Organizations) are groups of healthcare providers that provide care based strictly on the "BEST EVIDENCE". In other words, if you can't back it up with peer-reviewed research (as crooked as that research may be --- click the link), it's not happening. ACO's also get fined or paid at a lower rate when patients relapse or are readmitted to the hospital for the same problem(s) they went in for in the first place. Are ACO's good? Like so many other Orwellian-named governmental organizations, it might look good on paper. Unfortunately, reality is often 180 degrees different than utopian thought processes.
Back in 2012, Dr. Harriet Hall of Science-Based Medicine wrote that, "For a healthy, asymptomatic patient, the physical exam with the laying on of hands and stethoscope and other rituals is pretty much meaningless. If nothing is found, it can produce false reassurance. If something is found, it is not likely to prolong the patient’s life and it has a significant likelihood of leading to harm from unnecessary treatment or from a diagnostic cascade of tests, unnecessary surgeries, unnecessary expense, and unnecessary worry."
On February 1 of 2011, she wrote a book review that everyone would do well to at least skim. The book, Overdiagnosed: Making People Sick in the Pursuit of Health, explains why Annual Physical Examinations are more likely to kill you than to save you (a point that my brother --- an ER physician --- would heartily agree with). Despite that fact that the average American believes it's always good to discover health problems early, three decades of data is not bearing this out (see my earlier link on "Prevention").
And lets be honest with each other for just a moment. What are Annual Physicals really? They certainly cannot be called "preventative" in any real sense of the word. Preventative Care is something you do for yourself --- not something your doctor does for you (HERE). Whether you are currently "sick" (you have overt symptoms) or not; if you are not taking care of yourself, sooner or later you will be "sick" --- officially.
When you think about it, it's not a surprise that Annual Physicals have been proven to be worthless. For the most part, they are nothing more than the endless cycle of a dog trying to catch his tail --- chasing symptoms and prescribing DRUGS --- drugs that cause reactions that are not reported to the proper reporting agencies about 99% of the time (HERE). In fact, if you want to see how big a mirage drugs are as far as managing DISEASES OF LIFESTYLE are concerned, I would suggest you read THIS SHORT POST.
Dinosaurs are definitely cool (I've written about them previously in a post on Fascia --- HERE). However, they shouldn't be playing a major role in our nation's healthcare. If you enjoy this site, make sure to tell others about it. While you are at it, help us reach more people by liking us on FACEBOOK.