Healthism, medicalization and overdiagnosis

Healthism is a term coined in the early 1990s that describes the government’s use of propaganda and coercion to establish norms of health” and its attempts “to impose norms of a ‘healthy lifestyle.'”

Think about the cities that have chosen to ban smoking or trans-fats or super-sized sodas.

Or the new federal school lunch program’s rather rigid nutrition standards.

Or the Affordable Care Act. It mandates coverage of multiple “essential benefits” such as annual “wellness visits” and screening exams of debatable value. It also requires health care providers to document that they’ve talked to every patient about weight … Continue reading

How to prevent colon cancer

I read a good post by a physician: 3 ways to prevent colorectal cancer

I didn’t know this, but apparently March is National Colon Cancer Awareness Month!

The author is a gastroenterologist, so his advice is probably as good as you’re going to get (there are no 100% guaranteed ways to prevent any type of cancer, after all).

Read his full post for details, but here are the highlights:

Know your family history

Your risk depends in large part on your family history, your age, and your personal health history. Have a discussion with your physician about screening guidelines.

Get

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Better patient education for mammograms

I’ve mentioned in several posts that I think screening tests, especially mammograms, are used too widely in this country. Every woman over age 40? Every year? It’s overkill.

Even the US Preventive Services Task Force (USPSTF) only recommends a screening mammogram every other year between the ages of 50 and 75.

But most women still think the yearly mammogram is health care at its finest.

Related post: Screening mammograms—benefits vs harms

The British medical journal, Lancet, recently published a study that shows women who are better informed about the risks and benefits of screening mammograms are less likely to … Continue reading

Number Needed to Harm

I’ve written a couple of posts about the Number Needed to Treat, aka the NNT. That’s the number of people that must be treated with a drug, a procedure or a screening test to save one life.

The lower the number, the better.

Related post: Number Needed to Treat

Well, the dark twin of the NNT is the Number Needed to Harm, or the NNH. How many people can be treated before one person is harmed? In this case, the bigger the number, the better.

Aaron Carroll, MD, of The Incidental Economist blog, wrote a terrific piece in The New Continue reading

Screening mammograms – benefits vs. harms

The Journal of the American Medical Association (JAMA) published a short article on screening mammograms that included a spiffy infographic on the benefits vs. the harms.

Looking at the graphic I can easily see that if 10,000 50-year-old women are screened, 10 will be “saved”, but 940 will undergo an unnecessary biopsy and 57 will be overdiagnosed. (For copyright reasons I can’t reprint the graphic here, but you can view see it yourself by clicking on the above link.)

The author of the article explains:

Another possible harm of screening is overdiagnosis. This means finding something on a mammogram

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Lack of transparency keeps medical costs high

Profits stay high, too

On Monday, the New York Times published another brilliant piece by Elisabeth Rosenthal in her series “Paying Till it Hurts.”

Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue.

And American doctors, clinics and hospitals tend to order lots of tests. “It’s one of the most lucrative revenue streams they

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Vitamin D testing and supplements

Lack of support for vitamin D

I’ve written several posts on vitamin D. That’s because it’s one of my pet peeves.

Why?

Because there was a lot of hype surrounding it several years ago when it became the latest health care fad. Suddenly a low vitamin D level was suspected of contributing to many types of cancer and chronic diseases. Physicians began testing everyone’s vitamin D levels and recommending vitamin D supplements, either over-the-counter or a stronger prescription form.

Further research on vitamin D, however, has not provided evidence that general screening for low vitamin D levels is helpful, … Continue reading

Harvoni, Solvadi and hepatitis C screening

harvoni hepatitis c treatmentNew treatments for hepatitis C

I read an article online the other day in which the author practically shouted at her readers to “Run as fast as you can to your doctor’s office and get screened for hepatitis C!”

OK, what she actually wrote was:

Overall, the outlook for patients with hepatitis C is much better than it was just a couple of years ago. So if you’re a baby boomer who hasn’t been screened for hepatitis C yet, don’t wait. 

Still, let’s step back and look at the big picture.

Hepatitis C screening has been in the news a … Continue reading

Three questions to ask your physician

demand-evidenceBe a proactive patient

In addition to talking to my doctor friends, I spend a lot of time reading various doctor blogs because I want to better understand our health care system from their unique point of view.

The majority of those I read seem to agree with me that the industry has morphed into a giant profit-making machine—profits first, patients second. Many physicians write of their loss of autonomy and the ability to treat patients in a thoughtful, patient-centered and cost-effective way.

More than ever, they say, patients need to be informed and take control of their health care. … Continue reading

The demise of annual exams and the doctor-patient relationship

Are annual exams a waste of money?

Based on the most recent evidence, I would argue yes. I posted about annual exams a few months ago, and quoted the following from the Society for General Internal Medicine (a primary care specialty group):

Routine general health checks are office visits between a health professional and a patient exclusively for preventive counseling and screening tests. In contrast to office visits for acute illness, specific evidence-based preventive strategies, or chronic care management such as treatment of high blood pressure, regularly scheduled general health checks without a specific cause including the “health maintenance” annual

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Do you need an annual pelvic exam?

annual pelvic exams unnecessaryYet another screening exam found unhelpful

Earlier this month, the American College of Physicians (ACP) published its recommendation in the Annals of Internal Medicine that routine annual pelvic exams are unnecessary for healthy, non-pregnant women with no gynecologic symptoms (bleeding, discharge, pain, etc.).

The ACP looked at evidence on pelvic examinations dating back almost 70 years and concluded:

… no data support the use of routine pelvic examination (excluding cervical cytologic [Pap] examination) for reducing the morbidity [disease] or mortality [death] of any condition. Furthermore, limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety,

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Do you need an annual exam?

The yearly reminder

The other day I received in the mail a form letter from my physician’s office reminding me that I am due for my annual “well woman” visit. The letter also pointed out that if I have an ACA-compliant health insurance plan, the cost for the exam would be 100% covered as a preventive benefit.

I have three problems with this letter.

  1. Although my current physician is part of my new insurance plan’s network, the hospital she works out of is not. What if I needed to have surgery or be hospitalized? My care would then be given
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Save money by Choosing Wisely

save money choosing wiselyUnnecessary care = unnecessary expense

Every day I see a new article about the high costs of health care.

A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn’t need — overtreatment that cost as much as $8 billion.

Use of [Mohs] surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its

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Screening for Alzheimer’s and dementia

Will there soon be a blood test?

My father-in-law recently passed away after suffering with Alzheimer’s for several years. I also have an aunt who is currently living with some form of dementia, probably vascular.

Few diseases strike more fear into those over the age of 50 than Alzheimer’s. Needless to say, both my husband and I worry when we find ourselves saying:

“Oh, what’s the word I want?”

or “Where did I put it?”

or “Why did I come in here?”

So when I read the prevailing health headlines this week about a blood test to predict Alzheimer’s, … Continue reading

Do you need an annual mammogram?

mammogramThe latest report

Most of my nursing career was in breast cancer, so I like to stay current on the most recent research on screening, diagnosis and treatment.

Earlier this week, the British Medical Journal released a pretty stunning report:

In conclusion, our data show that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40-59.

In normal language that translates to “annual mammograms don’t save lives.”

Aaron Carroll, MD, writes on his blog:

This study is going to make a whole lot of people upset. It’s a large, well designed

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