Health News Review

Harriet Hall writes on the Science-Based Medicine website about a 21-year old man seeing a board-certified family physician for a routine physical.  Excerpt:

This young man is healthy, has no complaints, has no past history of any significant health problems and no family history of any disease. The patient just asked for a routine physical and did not request any tests; the doctor ordered labwork without saying what tests he was ordering, and the patient assumed that it was a routine part of the physical exam. The patient’s insurance paid only $13.09 and informed him that he was responsible for the remaining $3,682.98 (no, that’s not a typo). I have a copy of the Explanation of Benefits: the list of charges ranged from $7.54 to $392 but did not specify which charges were for which test. It listed some of the tests as experimental and not covered at all by the insurance policy, and one test was rejected because there was no prior authorization. …

Here’s a list of the tests they did on this young man:

  • Lipids: total cholesterol, LDL-C, HDL-C, Triglycerides, Non-HDL-C
  • Lipoprotein Particles and Apolipoproteins: Apo B, LDL-P, sdLDL-C, %sdLDL-C, Apo A-1, HDL-P, HDL2-C, Apo B: aApo A-1 Ratio, Lp(a) Mass, Lp(a)-P
  • Inflammation/Oxidation: Fibrinogen, hs-CRP, Lp-PLA, myeloperoxidase
  • Myocardial Structure/Stress/Function: Galectin-3, NT-proBNP
  • Platelets: AspirinWorks (urine) Ppg/mg of creatinine
  • Lipoprotein Genetics: CYP2C19*2*3, CYP2C19*17
  • Coagulation Genetics: Factor V Leiden, Prothrombin Mutation, MTHFR (C677T), MTHFR (A1298C)
  • Metabolic: 25-hydroxy-Vitamin D, Uric Acid, TSH, Homocysteine, Vitamin B12
  • Renal: Cystatin C, Estimated Glomerular Filtration Rate, Serum creatinine
  • Electrolytes: sodium, potassium, chloride, CO2, calcium
  • Liver: ALT/GPT, AST/GOT, ALP, Total bilirubin
  • Renal: Creatinine, BUN
  • Thyroid: TSH
  • Others: Albumin, Total protein, Ferritin
  • Omega-3 fatty acids: ALA, DPA, EPA, DHA
  • Omega-6 fatty acids: Omega-6 total, Arachidonic acid, Linoleic Acid
  • Other fatty acids: cis-monosaturated total, saturated total, trans total.

According to most published guidelines, a routine physical on a 21 year old male should include BP, weight, updating immunizations (and offering HPV vaccine), inquiring about risk factors, and counseling, as appropriate, about lifestyle issues like safe sex, smoking, alcohol, diet, exercise, etc. NO lab tests are recommended except for possibly checking lipids or HIV status, which most guidelines do not advise in the absence of risk factors.

I will not comment further, as I feel incapable of moderating my language.

At last check, well more than 100 comments were left on the website in response to the article.

I frequently write about the poor public dialogue about screening, overdiagnosis and overtreatment.  This example brings home the point about why that’s important.

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Comments

john halpin posted on July 11, 2014 at 12:51 pm

please list doctors name and address.The public needs to be warned about this doctor.

Reply

    Gary Schwitzer posted on July 11, 2014 at 1:17 pm

    John,

    Thanks for your note. You should direct your question to Harriet Hall, who wrote the piece in question.

    Reply

Linda Pifer, Ph.D. posted on July 14, 2014 at 9:19 am

This is worse than shocking. This physician would benefit from sitting in on appropriate laboratory utilization lectures. Where has common sense gone?

Reply

    Jeanne Lenzer posted on July 14, 2014 at 9:57 am

    I’d go a bit further, Gary. I would not recommend an HPV vaccine as it is as yet unproven (claims are based on surrogate markers): http://bit.ly/FOiVCP and http://bit.ly/QLgQ2g – nor would I order lipids in this otherwise healthy 21-year-old who is not a candidate for statins as he will be low risk (if one uses the reasonably more reliable NHLBI calculator http://cvdrisk.nhlbi.nih.gov/ rather than the new industry-approved but unvalidated calculator recommended by the AHA/ACC. He simply doesn’t need blood work (save any STD issues).

    Reply

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