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
    magnesium water can be good for your health but you can't have too much
    Is Drinking Magnesium Water Good for Your Health?
    October 17, 2023
    common misconseptions about brain injuries
    4 Common Myths and Misunderstandings About Brain Injuries
    February 5, 2023
    get a career in medical device sales
    What Are the Benefits of Attending Medical Sales College?
    April 10, 2023
    Latest News
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 17, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
  • 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
    Elective Coronary Stenting: A Case in Context
    August 3, 2011
    PSA screening: Does It or Doesn’t It?
    March 16, 2012
    Rick Perry Needs To Make Up His Mind
    September 19, 2011
    Latest News
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
    How Health Choices and Legal Actions Intersect After an Injury
    July 17, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 17, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Screening and Prevention: Separating the Wheat from the Chaff
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
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
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

4 Important Ways Healthcare Technology Improves Your Patient Care
5 Reasons Latinos Could Be The Most Powerful Transformation Of The U.S. Health System
Health Insurance Unaffordable for Smokers?
Seeing Red for Heart Health
How Western Companies Can Capitalize on the Opportunities in India

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 healthscreening programs
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
How IT and Marketing Teams Can Collaborate to Protect Patient Trust
Global Healthcare Policy & Law
July 17, 2025
paramedics in surgical gloves and masks
How Health Choices and Legal Actions Intersect After an Injury
Health care
July 16, 2025
a woman giving a key
How Probate Planning Shapes the Future of Your Estate and Family Care
Health
July 16, 2025
a woman with kinesio tapes on her back arm
How communities and healthcare providers can address slip and fall injuries with legal awareness
Health care
July 16, 2025

You Might also Like

Florida Rejects Fed Appropriations for Creation of Healthcare Exchanges

August 2, 2011

Paul Ryan’s Medicare Reform Falls Short

April 8, 2011
Health_Care_Reform_Image2-400x300
Policy & Law

Report:PPACA Would Reduce Number of Uninsured from 50 million to 26 million

February 16, 2012

How Stronger Residency Directors and Board Certification Can Work Together

March 12, 2012
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?