Let's Get (A Real) Physical ...

Earlier this week, I went to my doctor to get a physical.

What a joke.

Nurse came in, took some blood and, because I have a heart condition, administered an electrocardiogram (EKG). After a few minutes, doctor entered, looked in my ears and mouth, listened to me breathe for a bit, asked me a few questions about my general health and the back/leg pain I was experiencing last time I saw her, and then sent me on my way to deposit some urine and check out. All in all, it took less than 25 minutes from the time I entered the doctor's office to the time I paid my rather exorbitant $35 co-pay, and that's including the waiting time.

Sometime early next week, I will get the results back from my blood and urine tests, and the numbers will all likely come back within the 'normal' ranges, suggesting I am the rather healthy 35-year-old male I appear to be.

But the question will remain, am I really healthy??

I firmly believe we will one day soon regard the current diagnostic procedures and preventative methods of our health system as incredibly rudimentary and insufficient. I mean, people tend to get their cars checked out with much greater detail and frequency than they do their own bodies. Airlines inspect their airplanes after every flight, and the most we do is get a doctor to take a quick look-see at us every so often (and maybe get the occasional mammogram or colonoscopy when we get a lot older)?

It makes no sense. The no. 1 killer in the world is cardiovascular disease, and cancer is expected to overtake the top spot by 2010, according to the World Health Organization. In both diseases, early diagnosis is an extremely important factor in determining whether treatment is successful, and yet symptoms often don't appear until it is too late. How many people have you known or heard about who seemed perfectly healthy, only to find out later they suffered a heart attack or developed late-stage cancer?

We spend billions and billions of dollars every year on cures and medicines for all sorts of diseases, many of which end up being ineffective ... when an earlier diagnosis would often result in much simpler, cheaper and more effective treatment options.

If only we could develop a safe way to comprehensively examine our internal systems on a regular basis, to see if tumors are spreading, arteries are clogging, etc.

Oh but wait! We pretty much have done just that...

Magnetic Resonance Imaging machines, or MRIs, actually do take detailed, accurate pictures of a person's entire insides. Unlike X-Rays or CT scans, which use radiation to complete a similar function, MRIs are generally considered safe (if a bit difficult to endure for anyone who's even slightly claustrophobic). Yet despite the MRI's impressive capabilities, they are still only used after symptoms present themselves and even then with some reluctance because of their high cost.

Around a decade ago, private clinics started popping up all over this country, offering full-body scans using either CT or MRI technologies. Given Americans' obsession with fighting aging and staying fit, you'd think these clinics would have done quite well. Yet they started going out of business almost immediately, thanks in large part to the high cost of the machines (several million dollars) and the uninsurable exams ($600 to $3000), as well as some extensive negative lobbying by traditional health care providers, including an HMO industry that was likely very worried they would one day be asked to reimburse patients for these tests.

The full-body scans were unnecessary and dangerous, most health-care experts argued, saying that in addition to the radiation of the CT scans, the tests don't accurately diagnose all diseases, resulting in a lot of false negatives as well as false positives.

False negatives can certainly lead to unhelpful patient complacency, but since cost is what drives almost every medical decision nowadays, I'm guessing it is the false positives and all the subsequent expensive and invasive follow-up tests that most disturb the insurance companies.

But meanwhile, the technology in an MRI machine has since gotten a good deal more powerful and effective. Could it be that the early diagnosis of treatable diseases would end up saving the health industry money in the long run?? Has anyone done a detailed study on that cost/benefit equation?? And what, exactly, is the 'cost' of a life, anyway? Shouldn't that matter??

A German university did a study a few years back where they gave full-body MRIs to 298 'healthy' patients and found something 'relevant' in 169 cases, 75% of which were confirmed by follow-up exams. Among the problems discovered included twelve colonic polyps, nine pulmonary lesions, and two previously undiscovered heart attacks. Twenty-one percent of the patients demonstrated atherosclerotic disease, while 12 percent had peripheral vascular disease.

Only one false positive was found in the study. And yet the researchers still concluded that full-body MRI scans 'should not be performed outside of a research setting due to the uncertainty of whether the benefits outweigh the risks.'

Like I said, what a joke.