By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    healthcare cybersecurity
    4 Helpful Tips on How to Protect Your Medical Practice Against Cyber Attacks
    October 24, 2021
    Health Check Diagnosis Medical Condition Analysis Concept
    6 Health Woes With Online Remedies
    January 19, 2022
    Eight Things Men Should Know About the Male Menopause
    Eight Things Men Should Know About the Male Menopause
    April 24, 2022
    Latest News
    5 Self-Care Habits to Help You Live an A+ Life
    September 20, 2023
    Keep Employees Safe & Healthy By Reducing Warehouse Injuries
    September 20, 2023
    What is Pneumonia? Causes, Treatment, and Care
    September 19, 2023
    Navigating Through the Essentials: Medical Billing Training for Beginners
    September 12, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Image
    Physician Patient Communication
    December 24, 2012
    health-care-reform-overview
    Healthcare Reform’s Impact: Staff and Service Cuts Expected
    December 15, 2011
    Smokers Die Ten Years Sooner Than Nonsmokers
    February 15, 2013
    Latest News
    Job Seekers with Disabilities Should at Health Insurance Benefits
    September 12, 2023
    Reasons That Drug Prices Are Rising to Unsustainable Levels
    September 12, 2023
    How Revenue Lifecycle Management Helps Healthcare Providers to Optimize Business Operations
    September 6, 2023
    The Hidden Benefits of Practice Exams for Medical Professionals
    September 6, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Screening and Prevention: Separating the Wheat from the Chaff
Share
Sign In
Notification Show More
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Public Health > Screening and Prevention: Separating the Wheat from the Chaff
DiagnosticsPolicy & LawPublic Health

Screening and Prevention: Separating the Wheat from the Chaff

GlennLaffel
Last updated: 2011/07/06 at 12:10 PM
GlennLaffel
Share
7 Min Read
SHARE

In the last month, the Obama administration announced programs to reduce racial disparities and increase prevention in health care. Neither program was funded with actual money, so they are about political showmanship as much as any real desire to tackle the worthy causes. After all, who would oppose such programs?

In the last month, the Obama administration announced programs to reduce racial disparities and increase prevention in health care. Neither program was funded with actual money, so they are about political showmanship as much as any real desire to tackle the worthy causes. After all, who would oppose such programs? I half-expect the administration to follow-up these announcements with one focusing on moms and apple pie.

But have a closer look at what Iowa Democrat Tom Harkin said at the press conference introducing the latter initiative. “For every dollar we invest in prevention, we save $6. We need to provide an approach that makes it easier to be healthy and harder to be unhealthy.”

I haven’t found the report on which Harkin bases his assertion about the returns on health prevention efforts, but my sense is its more complicated than Harkin would have us believe. Some screening and prevention programs are not effective at all. Others are effective, but prohibitively expensive. Any national program to improve prevention needs to evaluate each potential component to assure it reflects Harkin’s focus on cost-effectiveness.

More Read

trust ligitation end of life

Understanding Trust Litigation When Dealing with Health Issues

The Journey to Healing: Navigating the Aftermath of Wrongful Death Claims 
Navigating Immigrant Police Encounters When Getting Healthcare
How Personal Injury Law Supports Your Wellbeing
7 Tips for Improving Reproducibility and Efficiency in the Lab

Many recently proposed screening programs do not meet this criterion, in fact. Let’s take a look at a few of them.

Screening for Prostate Cancer
Two months ago, scientists reported the results of a 20-year follow-up study of 1,500 Swedish men between the ages of 50-69. The study found that routine screening for prostate cancer did more harm than good. The screening program (which included digital rectal exams and prostate-specific antigen tests) enabled physicians to detect and treat nearly a third more cancers, but there were problems with overtreatment and treatment related side-effects. More importantly, prostate cancer death rates were the same in the screening group as they were in the control group. 

Those findings were consistent with an earlier meta-analysis of prostate cancer screening programs involving nearly 400,000 men. In that analysis, men who were screened were diagnosed with the disease 46% more frequently, but the marginal increase was limited to early-stage forms of the disease. And here again, there was no survival benefit.

Spiral CT Screening for Lung Cancer
Last fall, a much heralded trial showed that screening spiral CT scans reduced lung cancer deaths by 20% in current and former heavy smokers. However, the absolute cancer death percentages in the study were low: 1.3% for subjects receiving the CT scan and 1.7% in those receiving chest x-rays. The absolute difference in death rates was therefore about 4 in a thousand, and the direct cost per life saved was ridiculously high: $180,000.

That’s not counting the indirect costs. Fully 25% of the subjects who received the CT scan had a false positive result, many of which triggered additional scans, lung biopsies and even thoracic surgery. Spiral CT scans can cost up to $1,000. A screening program using this technology would cost many tens of billions of dollars per year.

Overuse of Colonoscopies
In this instance, the issue wasn’t the initial colonoscopy, but unnecessary repetitions of the screening procedure in patients in which the initial test was negative. Scientists from the University of Texas found that that 46% of Medicare enrollees that had negative colonoscopy findings from 2001 through 2003 underwent another colonoscopy within 7 years. Even in patients who were at least 80 years old (and who were thus more likely to die of something other than colon cancer), repeat exams within 7 years were done on 33%. Interestingly, although Medicare supposedly prohibits reimbursement for screening colonoscopy within 10 years of a negative exam, it denied only 2% of the claims for the repeat procedures.

ECG Screening for High School Students
The American Heart Association recommends that high school athletes undergo pre-participation screening, including a physical exam and a family and personal medical history, but not an ECG. However, in the wake of the tragic death of a star basketball player, scientists in the Chicago area undertook a program to screen all 50,000 students with ECGs, as well.

They found previously unrecognized ECG abnormalities in 2.16% of the students, although the vast majority of them were trivial (left atrial enlargement, for example). A parallel analysis revealed that 1,500 students with false positive tests would be referred for further testing for every life saved. Nearly all of the editorials accompanying the report of the Chicago program suggested that this “collateral damage” was unacceptably high.

What Can We Make of This?
The Obama administration’s new (albeit non-funded) emphasis on screening and prevention isn’t just about political theater. Of course a program like this can save lives and money! But administrators of such a program have to do the spade work on each and every component of such an initiative. In all likelihood, none of the procedures mentioned above would make the cut for such a program.

With prevention and screening, it’s essential to separate the wheat from the chaff.

TAGGED: public health, screening programs

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
GlennLaffel July 6, 2011
Share This Article
Facebook Twitter Copy Link Print
Share
Previous Article Health Care Buzz Today
Next Article Physical and Emotional Health of Older Married Couples Tied Cloesly Together

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

abdominal pain
The Impact of Abdominal Pain on Female Health
Women Health September 20, 2023
5 Self-Care Habits to Help You Live an A+ Life
Health September 20, 2023
warehouse worker health and safety
Keep Employees Safe & Healthy By Reducing Warehouse Injuries
Health September 20, 2023
self-care tips for nurses
Self-Care is Critical for NICU Nurses, Here’s Why
Nursing September 19, 2023

You Might also Like

health insurance disability
Policy & Law

Job Seekers with Disabilities Should at Health Insurance Benefits

September 12, 2023
rising drug costs
Pharmaceuticals

Reasons That Drug Prices Are Rising to Unsustainable Levels

September 8, 2023
healthcare providers
Hospital Administration

How Revenue Lifecycle Management Helps Healthcare Providers to Optimize Business Operations

September 6, 2023
Medical Professionals exams
Medicare

The Hidden Benefits of Practice Exams for Medical Professionals

September 6, 2023
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US
© 2008-2023 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Lost your password?