Preventive Medicine – Protecting Yourself from Serious problems

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a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. Judging the overall effect on medical spending requires analysts to calculate not just the savings from the relatively few individuals who would avoid more expensive treatment later, but also the costs of the many who would make greater use of preventive care.

Smoking Cessation Advice and Help to Quit

The harms of smoking are self-evident. It is estimated that smoking results in $100 billion annually in medical costs. Smoking also creates collateral damage to those non-smokers passively exposed. Clinicians should screen all adults to determine if they smoke or use other tobacco products, provide brief counseling, and offer patients nicotine replacement therapies and referrals to help them quit. What is most frustrating is that nicotine, as addictive as heroin and cocaine, is tolerated at all by our society – and that many health insurance companies will not pay for smoking cessation counseling or meds to help patients quit.

Screening for Alcohol Misuse and Brief Counseling

15% of adults report excessive drinking binges, more commonly in younger adults but still quite prevalent in older. Harmful alcohol use is associated with violence, accidents, injuries, deaths and disability, social disruption, and health problems. Many doctors consider more than 7 drinks/week or 3 drinks/occasion risky for women, and 14 drinks/week or 4 drinks/occasion hazardous for men, but in the context of certain activities like driving no amount is safe. Many people are unaware that their alcohol use is excessive and will change their habits when a doctor points it out.

Colorectal Cancer Screening

Colonoscopy remains the gold standard for early detection and prevention of colon cancer, although other options include fecal occult blood testing and sigmoidoscopy. Colon cancer is the 3rd highest incident cancer in the U.S. with 160,000 new cases in 2008, and 55,000 deaths. 19,000 deaths could be prevented each year if people over age 50 were periodically screened as recommended. It is estimated that only 1/3 of adults are up to date with screening. The risks of colon perforation are quite small but should be discussed with the doctor.

Hypertension Screening

It recommended that blood pressure be measured routinely in all adults over 18 and that anti-hypertension medications be taken to prevent the incidence of cardiovascular disease. 30% of American adults have hypertension, resulting in at least $100 billion in medical costs. Due to various factors only 1/3rd of hypertension cases are controlled. Many suitable generic medicines exist in this category. A low salt diet, weight loss, and exercise are also very effective means to lower blood pressure.

Influenza Immunization

The Advisory Committee on Immunization Practices recommends annual flu shots for those adults over 50 years of age, women who will be pregnant during the flu season, persons with certain chronic medical conditions, children 6 months to 18 years old, and several other important adult and pediatric groups you can review at the CDC. Influenza contributes to 35,000 deaths in the U.S. each year, many hospitalizations, absenteeism and presenteeism at work. The flu shot has been proven to protect against getting the flu to varying degrees based upon patient characteristics and each year’s serological match.

Vision Screening

Recommended especially for elderly persons using a Snellen acuity test (the one that hangs on the wall). Very cost effective, and vision correction can reduce hip fractures from falls, improve quality of life, reduce accidents, help with proper use of medication bottles, and increase activities such as exercise. Up to 25% of older people wear inappropriate visual correction.

Cervical Cancer Screening

While the starting age and interval between Pap smears is currently in debate again, screening for cervical cancer in women is certainly effective. It is largely responsible for the 50% decline in cervical cancer mortality over the past 30 years. Further long-term benefits remain to be studied for the HPV vaccination series, but this also looks quite promising for women. The American College of Obstetrics and Gynecology released new guidelines just last month, but these are still quite new and your doctor may advise more frequent screenings.

Cholesterol Screening

The U.S. Preventive Services Task Force Recommends: “Screen routinely for lipid disorders among all men aged 35+ and all women aged 45+. Also screen men aged 20-35 and women aged 20-45 if they have other risk factors for coronary heart disease. Treat with lipid-lowering drugs to prevent the incidence of cardiovascular disease.”

The facts cited by the report are convincing:

~21% of adults age 35+ have high cholesterol. Of these, most will develop high cholesterol before age 55.

~One out of 4 adults who do not control their high cholesterol will have a cholesterol-attributable heart attack. One out of 3 will die of cholesterol-attributable coronary heart disease.

~Long-term use of therapies is necessary to achieve maximum benefits of screening

There you have it, the top ten preventive services for the U.S. population, ranked based upon an evidence-based analysis of costs and impacts of benefits and harms.

Other clinical preventive services that are valuable include pneumococcal vaccination, breast cancer screening for women, discussing calcium supplementation, vision screening for preschool children, discussing folic acid supplementation for women of childbearing age, obesity screening in adults with high-intensity counseling about diet and exercise, depression screening, hearing screening in adults over 65, injury prevention counseling for parents of children 0-4 years of age, osteoporosis screening of women over 60-65, diabetes screening, diet counseling, and tetanus-diptheria boosters. Interestingly, PSA testing did not make the list. Most doctors still order this test annually in the absence of a better option for men, perhaps out of fear of missing prostate cancer and getting sued for it, regardless of the thorny question of whether early detection and treatment prolongs life.

Dr. Alber Ftiha M.D. – internal Medicine

(718) 627-8700
359 Avenue U Brooklyn NY 11223
Sunday ………. 8:30 – 3:00
Monday ………. 8:30 – 3:00
Tuesday ……… 6:00 – 9:00
Wed ………….. 8:30 – 3:00
Thursday …….. 6:00 – 9:00
Friday …………. 8:30 – 3:00

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