Cleveland Clinic’s Top 5 Tests for 2012 clash with many guidelines

(© Raths)

Last week, the Cleveland Clinic sent out the following “News Tips”:

“Top 5 Medical Tests for 2012

As we head into 2012, healthy New Year’s resolutions will abound. People will pledge to work out more, eat healthy foods and finally go to see their doctor for a physical.

Cleveland Clinic experts note that there are a few tests that everyone should have during their yearly physical. For men, the following tests are recommended by many physicians:”

Included in the list were:

  • “High-sensitive C-reactive protein – High levels of this inflammatory biomarker are predictive for future heart problems.” –  But the US Preventive Services Task Force, by comparison, states that “the evidence is insufficient to assess the balance of benefits and harms of using high-sensitivity C-reactive protein  to screen asymptomatic men and women with no history of coronary heart disease.”
  • “Vitamin D level – Low levels are associated with osteopenia, osteoporosis, breast cancer, colon cancer and heart disease.” But the Endocrine Society, by comparison, published a guideline recommending that doctors “screen for vitamin D deficiency in people at risk for deficiency, including obese individuals, blacks, pregnant and lactating women, and patients with malabsorption syndromes. “We do not recommend population screening for vitamin D deficiency in individuals who are not at risk,” the Society’s task force chair said.
  • “PSA level – To screen for prostate cancer.” Do we really need to go through this again? The US Preventive Services Task Force doesn’t make that recommendation.  The American Cancer Society doesn’t.  This kind of blanket recommendation for men of all ages to be screened for prostate cancer does not reflect the growing call for fully-informed, shared decision-making to take place regarding PSA testing.

Then the Cleveland Clinic news tips goes on to say:

“Women do not have to have the PSA test, but they should have a routine breast exam and pap smear.”

But, by comparison, the USPSTF states that “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older” and the Memorial Sloan-Kettering Cancer Center states that clinical breast exam “adds little to mammography in reducing breast cancer deaths.”

Even the opening overall premise of the “News Tips” – that everyone should have a yearly physical – is a simplistic one-size-fits-all premise that is not universally endorsed.

We’re going to see a lot of these “what to do in the New Year” health tips columns.   We hope more of them are more evidence-based than this one was. And we hope that journalists don’t act on these news tips without doing their own  homework on the state of the evidence.

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Chris Johnson

December 19, 2011 at 11:02 am

“For men, the following tests are recommended by many physicians:”

What a weasel way for the Cleveland Clinic (or the journalist) to put it.

Instead, try: “For men, the following tests are often and inappropriately recommended by many physicians.”

Marilyn Mann

December 19, 2011 at 11:41 am

I don’t have the guidelines on screening for cervical cancer memorized, but I believe for some groups of women the recommendation is for a Pap smear every 3 years.

Steven J. Raphael

December 19, 2011 at 3:05 pm

There is a wide range of people (generally younger and healthier) that are not recommended to get a “yearly” physical either.

Steven J. Raphael

December 19, 2011 at 3:06 pm

Apologies on not reading thoroughly to the 2nd to last paragraph.

Susan Fitzgerald

December 19, 2011 at 4:39 pm

Wow, and this is often cited as one of the premiere health clinics in the country. Well, everybody’s got to watch their profit margin. Making health care affordable mean cutting into revenue streams. Thank you, Gary, for pointing out a few prime areas to start.

I’ll be tweeting this for